Article
Reference
The Development of Family Alliance From Pregnancy to Toddlerhood and Child Outcomes at 5 Years
FAVEZ, Nicolas, et al.
FAVEZ, Nicolas, et al. The Development of Family Alliance From Pregnancy to Toddlerhood and Child Outcomes at 5 Years. Family Process, 2012, vol. 51, no. 4, p. 542-556
DOI : 10.1111/j.1545-5300.2012.01419.x
Available at:
http://archive-ouverte.unige.ch/unige:30881
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The Development of Family Alliance From Pregnancy to Toddlerhood and Child Outcomes at 5 Years
Nicolas Favez, Francesco Lopes and Mathieu Bernard University of Geneva, Switzerland
France Frascarolo, Chloé Lavanchy Scaiola, Antoinette Corboz-Warnery, and Elisabeth Fivaz-Depeursinge
University of Lausanne, Switzerland
Author Note
Nicolas Favez, Francesco Lopes and Mathieu Bernard, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; France Frascarolo, Chloé Lavanchy Scaiola, Antoinette Corboz-Warnery and Elisabeth Fivaz-Depeursinge, CEF, IUP,
Department of Psychiatry, CHUV, University of Lausanne, Switzerland
This research was supported in part by the Swiss National Science Foundation, grant No 32-52508.97
Correspondence concerning this article should be addressed to Nicolas Favez, Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont d’Arve 40, 1211 Geneva 4, Switzerland. E-mail: nicolas.favez@unige.ch
Abstract
This paper presents a longitudinal study of the development of “family alliance” from pregnancy to toddlerhood in a community sample, as well as its links with the emotional and cognitive development of the child at age 5. Family alliance is defined as the quality of the interactive coordination between family members. We consider that the alliance constitutes a context for the child to learn emotion regulation and to develop an understanding of inner states. Family interactions (N = 38) were observed at the fifth month of pregnancy and at 3, 9, and 18 months after birth in a standardized situation of observation (Lausanne Trilogue Play).
Marital satisfaction and child temperament were assessed through self-reported questionnaires. Several outcomes of the child at age 5 were measured: theory of mind performances, predominant emotional themes in pretend play, internalized and externalized symptoms. Results show that (a) three patterns of evolution of family alliance occur: “high stable” (n = 19), “high to low” (n = 10), and “low stable” (n = 9); (b) a high stable alliance is predictive of better outcomes in children at age 5, especially regarding theory of mind; (c) the temperament of the child is predictive of child outcomes; and (d) an interaction effect occurs between family alliance and temperament. These results highlight the importance of both family-level and individual-level variables for understanding individual differences in the social and cognitive development of children.
Keywords: family alliance, mother-father-child interactions, child outcomes, transition to parenthood, longitudinal study
BACKGROUND
Family relations are the primary social learning context for the child (Walsh, 2009).
Several longitudinal studies have shown the significant influence of early interactions assessed at a family level—that is, implying more than two persons—on the emotional and cognitive development of the child during the first years (e.g., Jacobvitz, Hazen, Curran, &
Hitchens, 2004; McHale, 2007). Following the tradition of observation of interactions, we have studied the way that primiparous families coordinate in a play situation, the Lausanne Trilogue Play, during the first 2 years and documented its links with child development at 18 months (Favez, Frascarolo, Carneiro, et al., 2006; Favez, Frascarolo, & Fivaz-Depeursinge, 2006). This article presents the first results of a follow-up of this longitudinal study when the first child was 5 years old.
Role of Family-Level Variables in Child Development
The primary importance of social contexts for the development of the child has been long documented by studies of interactions in family subsystems such as the mother-child and father-child dyads. The influence of the quality of stimulations provided by the parents, their parenting practices, and the overall emotional tone of their relation with the child has been demonstrated in several domains of development, such as social skills and interactions with peers (Eisenberg et al., 1999; Parke, McDowell, Cladis, & Leidy, 2006); attachment behaviors and internal working models (Belsky & Pasco Fearon, 2008; De Wolff & van Ijzendoorn, 1997; Lamb & Lewis, 2010); and theory of mind and understanding of inner states
(Carpendale & Lewis, 2004; Ruffman, Slade, Devitt, & Crowe, 2006). Moreover,
disturbances in these relationships have been linked to psychopathology in children (Anders, 1989; Benoit, Zeanah, Boucher, & Minde, 1992).
Evidence of family-level processes first came from family therapists who described specific family interactive patterns that are linked to the affective functioning and eventually to the pathological condition of the child. The most prominent example is the triangulation process whereby the child is entrapped in the conflict between her parents and ends up acting as a go-between (Minuchin, Rosman, & Baker, 1978).
Studies on marital relations then showed that the relational dynamics in a subsystem in which the child is not directly involved as a participant—the husband-wife marital
subsystem—do have an impact on the child’s development (see, e.g., Cowan & Cowan, 1992;
Lewis, 1989). Indeed, marital dissatisfaction and intractable conflict between the parents have negative consequences on the emotional regulation skills of the child, either because the conflict alters the parents’ aptitude in parenting—the so-called spillover effect (Buehler et al., 1997; Erel & Burman, 1995, for a meta-analysis), or because the child learns maladaptive behaviors in order to protect herself against the negative emotions elicited by the parental conflict (Cummings & Davies, 2010). On the other hand, cooperation, resolved conflicts between parents, and an overall positive emotional climate in the family form a beneficial learning context for the child to understand multiple perspectives and to develop positive cognitions about social relationships (Raikes & Thompson, 2006).
Specifying further the effects of interparental dynamics, researchers have focused on the coparenting relationship, that is, the emotional and instrumental support the parents bring to each other in their relations to the child (Gable, Crnic, & Belsky, 1994; Minuchin, 1974).
Measures of the quality of overt coparenting (the interactive behaviors of parents in front of the child) and covert coparenting (what one parent says to the child about the other when he or she is not present) have been shown to be predictive of child outcomes, over and above measures of interactions in marital and parent-child subsystems (Frosch, Mangelsdorf, &
McHale, 2000; McHale & Rasmussen, 1998). Cooperation between the parents, warmth, and
promotion of family integrity during the first years are predictive of better adaptation during the preschool years and at school entry when compared with coparenting that is either conflictual or imbalanced (one of the parents systematically withdrawing from family life), which is associated with externalized and internalized symptoms (Jacobvitz et al., 2004;
McHale, 1997, 2007; Schoppe-Sullivan, Mangelsdorf, Frosch, & McHale, 2004; Teubert &
Pinquart, 2010).
Family Alliance and Child Development
Although studies on marital conflict and coparenting have considered the parent-parent relationship and its impact on the child, the measurement strategies rarely include the child herself (Favez, Frascarolo, Keren, & Fivaz-Depeursinge, 2009). In order to fill this gap, we have studied mother-father-infant triadic nonverbal interactions according to the model of family alliance, namely, the family’s ability to coordinate to successfully fulfill a task—be it to play together, to have a meal, or to participate in any kind of group activity (Fivaz-
Depeursinge & Corboz-Warnery, 1999). The alliance is determined by four interactive functions: participation, organization, focalization, and affect sharing. These functions are hierarchically embedded, as each one is a necessary condition for the achievement of the next:
(1) All family members must be included in the interaction (participation) so that (2) roles may be distributed: who will “talk” first, how turn taking is organized, who will be the game’s initiator and animator (organization). (3) Then, everyone’s attention must be focused on the same task in order to co-construct a coherent activity (focalization). (4) Emotions will then be able to circulate and a common pleasure can be shared (affect sharing). The more the
functions are fulfilled by the family, the better its overall coordination will be (Frascarolo, Favez, Carneiro, Fivaz-Depeursinge, 2004).
In a longitudinal study involving a community sample of primiparous families from pregnancy to 18 months after birth, we identified three patterns of evolution of the alliance:
Most families who showed good coordination skills during pregnancy (parents play with a doll representing the baby-to-be) were able to successfully play as a threesome with the baby once born—a pattern that we labeled as a “high stable” evolution. Some families showed a progressive decrease in the quality of interactions, which we referred to as a “high-to-low”
pattern. Finally, families for which coordination was difficult during pregnancy were still not able to reach good enough coordination throughout the first 2 years after birth; we labeled this pattern as “low stable” (Favez, Frascarolo, & Fivaz-Depeursinge, 2006). Marital self-reported satisfaction was one of the variables associated with the patterns, which is consistent with the results of longitudinal studies showing the links between marital relationship and family functioning (Cowan & Cowan, 1992; Lewis, 1989). Regarding child outcomes, our first results showed that the patterns are predictive of the social support that parents report to have received in their childrearing tasks from relatives outside the family (Favez, Frascarolo, Carneiro, et al., 2006). On the other hand, several outcomes were also explained by the child’s temperament. Emotionality was, for example, predictive of sleep behavior disturbances; this is in line with other developmental studies that have consistently reported temperament in explanation of a significant part of child development (e.g., Crockenberg & Leerkes, 2003).
Because we consider triadic interactions to form a learning context for children, we expect these patterns to have a long-term effect on child development at a cognitive as well as at an emotional level. In order to test this hypothesis, the families were seen again when the child was 5 years old. This paper aims to present the first results of this follow-up study.
HYPOTHESES
From the literature and our previous work, we formulated the following hypotheses: (a) The evolution of family alliance during the first 2 years is predictive of the social and
cognitive development of the child at age 5; specifically, a high stable evolution is predictive of better outcomes in children in terms of social behavior and understanding of others’ inner
states compared with a high-to-low or a low stable evolution; (b) because they were exposed to some periods of higher family coordination, children of families with a high-to-low
evolution have better outcomes than do children of low stable families; and (c) family alliance exerts an impact on child development along with other known factors of influence such as the marital relationship and the child’s temperament.
METHOD Sample
Thirty-eight nonreferred primiparous families were recruited through press
announcements and in a maternity ward during pregnancy. The children were 23 boys and 15 girls. All families were at a middle- to upper-middle socio-economic level (Hollingshead’s Index of Social Position).
Procedure
Families were received at our laboratory in the Center for Family Studies at the fifth month of pregnancy; at 3, 9, and 18 months after birth; and in the child's fifth year. Family interactions were video recorded in standardized situations of observation: the Prenatal Lausanne Trilogue Play (LTP) during pregnancy, the standard LTP at 3, 9, and 18 months;
and the PicNic Game (PNG) at 5 years. Questionnaires were completed by the parents in the laboratory after the observation situations. At 5 years, the cognitive and emotional
development of the child was assessed by individual testing.
This research and its protocol received approval from the Ethical Committee of the Faculty of Biology and Medicine of the University of Lausanne.
Situations of Observation
The Prenatal Lausanne Trilogue Play
In this situation, parents played out an encounter with their child (Fivaz-Depeursinge, Frascarolo-Moutinot, & Corboz-Warnery, 2010), simulated by a doll (with a baby's body but an undefined face). The experimenter asked the parents to play the following four-part scenario: In the first two parts, one of the parents plays with the “infant,” while the second parent is in a participant-observer position. In the second part, the parents switch roles. In the third part, the parents play together with the infant, and in the last part, the infant is left in the third party position while the parents talk to one another. The entire play was video recorded.
The mean duration of the prenatal LTP was 5.10 min (SD = 1.46 min).
The Standard Lausanne Trilogue Play
This play situation involving the father, mother, and baby together followed the same four-part scenario as the prenatal LTP (Corboz-Warnery, Fivaz-Depeursinge, Gertsch Bettens,
& Favez, 1993). When the infant was 3 and 9 months old, the parents sat on chairs and the child in a baby chair. When the child was 18 months old, the parents and child sat around a small round table. Various toys were at hand (wooden blocks, animals, a dinner set, a small hairbrush, a car). The entire play was video recorded. The mean duration was 11.30 min (SD
= 2.47). There was no significant difference in the duration of play between the three times.
In both versions of the LTP, we balanced the order of the first two parts: In 50% of cases, we asked the mothers to be first to play and in the other 50%, we asked the fathers.
The PicNic Game
In this play situation, the family was invited to engage in a pretend game of having a family picnic. The game was video recorded in a room equipped with a green carpet, a bench, a table, some chairs, dishes in a basket, and toys in bags. The instructions let the family
determine the duration of the game; the mean duration in this study was 15 min (Frascarolo &
Favez, 2005).
Assessment of Family Alliance
Prenatal alliance was assessed by using five Likert scales (with scores ranging from 0 to 2; Fivaz-Depeursinge et al., 2010): (a) coparental playfulness toward the task; (b) structure of the play; (c) intuitive parenting behaviors; (d) the couple’s cooperation; and (e) family
warmth. The scores of the five scales ( = .79) were summed to obtain a global score of between 0 and 10. The higher the score, the more functional the prenatal alliance is.
Postnatal family alliance was assessed with the GETCEF scale (Fivaz-Depeursinge &
Corboz-Warnery, 1999), which operationally evaluates the interaction across seven dimensions representing the interactive functions described earlier: (1) participation: (a) contextual (correct positioning of the child and timing of the play); (b) corporal (parents' pelvises and torsos oriented toward the child); and (c) visual (each partner can see the other in his or her peripheral vision); (2) organization: (a) corporal (distance between partners is appropriate for dialogue) and (b) visual (the three partners' faces are oriented toward each other); (3) focalization: the three partners co-construct a common play; and (4) affect sharing:
mutual expressions of emotions between the partners.1 Each part of the LTP is coded
separately. Each dimension is attributed a score between 0 and 2. Scores are added to obtain an alliance score of between 0 and 14 for each part of the play; adding the scores of the four parts results in a global score totaling a possible maximum of 56 points ( comprised between .78 and .86 for the three time points). The higher the score, the more functional the alliance is.
The PNG was coded with the Re-PAS Scales (Frascarolo & Favez, 2005); one scale was used for the present study: child autonomy, which assesses on a 5-point Likert scale the
degree to which the child is able to play by herself while being available to interact with other people when solicited.
Coding Strategy
Different pairs of independent coders assessed observational data at each measurement point, so that 10 different coders were involved.
The reliability of the coding of family alliance was assessed on 15 LTPs at each
measurement point. Intraclass coefficients (ICCs) for the prenatal LTP scores ranged between .68 and .94, for an average of .82; at 3, 9, and 18 months, coefficients ranged between.83 and .96, for an average of .88.
The reliability of the coding of child autonomy was assessed on 20 PNGs (ICC = .68).
Moreover, experimenters involved in the assessment of the 5-year outcomes were blind to the coding of the observational data.
Questionnaires
Marital satisfaction was assessed during pregnancy and at 18 months using the Dyadic Adjustment Scale (Spanier, 1976). This scale totals 32 items assessing various aspects of the couple's life, for a total score of between 0 and 160; the higher the score, the higher the marital satisfaction is. Parents filled in the questionnaire separately in the laboratory.
Temperament at 3 months was assessed by mothers. They completed Rothbart's (1981) Infant Behavior Questionnaire (IBQ); this questionnaire assesses six temperament dimensions derived from 90 items assessed on 5-point Likert scales: activity level, distress to limitations, fear, duration of orienting, smiling/laughter, soothability. We then computed Rothbart’s (1986) “negativity” index (mean of fear and distress to limitation dimensions; = .60) for subsequent analyses. Fathers and mothers assessed temperament at 18 months ( between .70 and .84). Separately, they completed the Emotionality-Activity-Sociability Survey (EAS;
Buss & Plomin, 1984). This questionnaire assesses four temperament dimensions on 5-point Likert scales: shyness, emotionality, activity, and sociability. As scoring between parents was highly positively correlated (all correlations: p < .01), we aggregated their scores by
computing the means for each dimension ( between .76 and .91). Following our previous results (see Favez, Frascarolo, Carneiro, et al., 2006), we kept only the dimensions of
emotionality and sociability for analyses, as they were the only dimensions to be significantly related to family functioning and children outcomes (high emotionality refers to intense negative emotional reactions and distress; high sociability refers to a search for social relations and a reluctance to be alone).
Child Outcomes at Age 5
The child’s behavior was evaluated through the Child Behavior Checklist completed by mothers (CBCL; Achenbach, 1991). This instrument assesses disorders in eight areas (e.g., aggressivity, social withdrawal, somatic complaints) according to 118 items evaluated from 0 to 2. Three different summary scores emerge from this questionnaire: internalized problems (31 items, scores 0 to 62), externalized problems (33 items, scores 0 to 66), and a total score of problems (116 items, scores 0 to 2322). The higher the score, the more the child is
considered to have difficulties.
The theory of mind was assessed with different kinds of false belief tasks conducted with stories staged with puppets: object transfer tasks (three stories), unexpected content (two stories), and “appearance/reality” distinction (one story; Wimmer & Perner, 1983). For each story, we ask the child questions about the theory of mind (e.g., what the character thinks is in the box), and about the understanding of emotions (e.g., what is the emotion felt by the
character?). One point is awarded for each correct answer given by the child, resulting in a theory of mind score of between 0 and 9 points and an emotion comprehension score of
between 0 and 10 points. The total score of between 0 and 19 is obtained by the sum of these two scores.
Spontaneous emotional themes were evaluated in the Family Doll Play. This is a situation in which the child is asked to tell, with puppets, the stories of a sad, a happy, an angry, and an anxious family. The number of aggressive, confrontational, and emotional events expressed or played out by the child are listed (e.g., the child makes one doll kick the other doll). The counting of these events provides three scores: aggressiveness, conflicts, and affection. Each score is then divided by the number of emotional elements mentioned in order to obtain a ratio of each emotion for the entire game (McHale, Neugebauer, Asch, &
Schwartz, 1999).
Language and general development were controlled by administration of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI III-R; Wechsler, 2005).
RESULTS Preliminary Checks
All children were in the norm of their developmental age. None of the study variables were correlated with the IQ (WPPSI III-R) or with the gender of the child.
Development of Family Alliance Across Time
First, replicating our previous procedure (see Favez, Frascarolo, & Fivaz-Depeursinge, 2006), we performed a cluster analysis following Ward's hierarchical method with squared Euclidian distance on the prenatal, 3-, 9-, and 18-month LTP z-scores (Filsinger, 1990).
Results showed the same three patterns of family alliance that we described in our previous paper (see Figure 1).
- Insert Figure 1 about here -
The first pattern was named high stable (n = 19), the second pattern high to low (n = 10), and the third pattern low stable (n = 9).3
Our previous results showed that the high-to-low pattern was paradoxically predicted by particularly high marital satisfaction (Favez, Frascarolo, & Fivaz-Depeursinge, 2006), which seems to indicate an exclusively “coupled-centered” functioning in parents. In the present study, we also tested the role of the temperament of the child in the development of the alliance. We found a difference only according to sociability (Kruskal-Wallis 2 = 8.1, p <
.05), which was significantly lower in children of the high stable group compared with the children of the high-to-low group (Mann-Whitney U = 42.00, p = .014). At first this seems to be a paradoxical result. However, an item-by-item analysis showed that this effect is mainly due to the scale “my child is something of a loner,” which is positively correlated with the other sociability scales, rather than negatively as expected; parents seem indeed to understand the “loner” component as a manifestation of autonomy rather than of not being at ease in a social context, which resolves the paradox. There might be a translation issue here.
Prototypical Development: Case Examples
In order to illustrate these different patterns, we describe hereafter representative aspects of the third part of LTPs (father, mother, and child all playing together) at the different points of measurement for families of the three groups.
High stable: Robert’s family
Robert’s family performs common games over the various LTPs. His parents take turns in the games suggested to the child. The games are adjusted to the age of the child. At 3 months, Robert, who has just eaten, shows some digestive discomfort. The mother then massages the child’s tummy and verbalizes these discomforts. The father imitates
vocalizations made by the child at that moment. The father then sings a nursery rhyme. The
mother joins in. Robert watches carefully and vocalizes at the end of the song. Both parents laugh and look at each other. At 9 months, a similar scene is observed. Robert is very interested in his father’s watch. The mother verbalizes the fact that the child is interested in the watch. The child looks at her and she proceeds to hide behind her hands. The father also plays this game and the child looks at both parents alternately, emitting screams of
excitement. When Robert is 18 months, the game is carried out symbolically. Some toys, such as plastic cups, are available. The parents suggest having a cup of tea. At first, the child is interested in other toys, which he proceeds to throw on the floor. The parents then say
“cheers” and start stirring their tea with a spoon. Robert watches them with a big smile on his face. He puts his hand out and says "tea." The mother then shows him her cup and the child looks inside. He then grabs the cup and takes a spoon to stir the tea. The mother gets a third cup and they all say “cheers.” In each LTP, the three family members are involved in creating the game together. By observing their gazes and the smiles exchanged, the observer has the impression that the three family members are sharing a moment of play and fun.
High to low: James’s family
When James is 3 months old, his family suggests games to their child that are similar to the games played in Robert’s family. James’s mother speaks to him softly and sings a song.
The father then suggests gymnastic moves with his arms and legs. During these moments of interaction, James intensively observes one parent after the other and smiles at his father at the end of the physical exercise. Following a smile from James, the parents laugh and James then looks at them intensively. This moment of sharing in the family is not seen in the other games played by this family. At 9 months, James is interested in his mother’s necklace. The mother leans over and verbalizes the colors she sees on the necklace. While the mother refers to the colors, the father tries at the same time telling a nursery rhyme while waving his hands in front of him. The mother continues to play with her necklace. James continues to look at
the necklace. The father then stops singing, leans back in his seat, and observes the room where they play. At 18 months, a similar game moment is observed. While the father offers a cup of coffee to his son, handing him a cup, the mother makes animal sounds and plays with the toy animals that are available (horse, cow, pig). James looks at the cup on one side, and the toy horse on the other side, then looks, puzzled, at his mother. The mother continues with the animal sounds. James then imitates a cow and turns to his father with a big smile on his face. His father then offers him a cup of coffee, holding out his cup. James turns back to his mother who then starts imitating a horse. The father then puts the cup down and leans back in his seat and observes, with little or no expression on his face, the game between James and his mother. Whereas at 3 months, we see a sharing family, at 9 and 18 months, James and his parents cannot find themselves in a common game: The parents suggest different activities and the father after a moment of competition withdraws from the interaction.
Low stable: Arthur’s family
Arthur’s family is, at any time, unable to play the games together, regardless of Arthur’s age. At 3 months, Arthur's mother rubs her hair on his belly. The father watches with no expression on his face. When the mother leans up a little, he leans over to Arthur, calls him several times and blows on his face. He then takes his son’s arms and shakes them. This time the mother shows an unexpressive face, apart from a fixed smile. Arthur sighs and his father lets his hands go. Instantly, the mother then leans forward and again rubs her hair on Arthur’s belly. The parents do not look at each other. This little sequence of play is indicative of a competition between the parents to catch the child’s attention, and the difficulty in creating a game that incorporates all three family members. This pattern repeats itself with the games played out at other ages. At 9 months, the baby is very interested in the seat he is in and the belt that holds him in. Meanwhile, the mother sings a nursery rhyme and the father looks at his son. Arthur takes a quick glance at his mother and continues to explore his belt. The father
decides to tickle the boy in a rather energetic way. The mother tells her husband that Arthur does not like to be tickled that way. The father stops the tickling, leans back on his chair, and looks only at his son. The mother tickles Arthur gently, who continues to look at his belt. The mother laughs loudly, and then tells her husband: "He’s really not interested in us." The father, without looking at her, produces a hint of a smile. He then leans over to Arthur and takes the belt in his hands. At 18 months, Arthur likes to throw toys on the floor. The mother tells him that if he continues, he will have nothing to play with. Meanwhile, the father offers to make animal sounds, but Arthur continues to throw toys on the floor. He looks at his parents once the objects are on the floor. The father picks the toys up off the floor. When he sits down again, the mother looks at him with a tense facial expression. The father takes the cow. Arthur starts imitating a cow. The mother then takes a cup and asks Arthur to make her some coffee. Arthur takes the cup and pretends to drink. The father then leans back in his chair and watches their son making drinking sounds. Arthur takes a quick glance at his father before waving his arms. His mother tells him he will spill the coffee. The father smiles, leans over to Arthur, and also takes a cup. The mother then announces that the game is over. In this family, the games reveal a competition between the parents to play with their child. When one of the parents plays a game, the other one plays another game, which results in the
interruption of the current activity. They can therefore not carry out an activity in which the three of them are involved.
Predictors of Child Outcomes at 5 Years Temperament
Several correlations are significant between temperament and child outcomes: Children who are more prone to express negativity at 3 months mention more conflict (r = .31, p < .05) and affection (r = .46, p < .01) themes in the Family Doll Play at age 5 and also have more internalized symptoms (r = .37, p < .05) and a higher total score in the CBCL (r = .42, p <
.01). At 18 months, the more children are rated as emotive, the more they mention conflict themes at 5 years (r = .40, p < .05) and the more they have externalized symptoms (r = .50, p
< .01) and a higher total score in the CBCL (r = .59, p < .01). Finally, the more they are sociable at 18 months, the more they mention conflict themes in the Family Doll Play (r = .33, p < .05).
Marital satisfaction
Marital satisfaction is not linked with any of the outcome variables.
Patterns of family alliance
Comparisons between the three patterns of family alliance were performed by means of a Kruskal Wallis one-way analysis of variance. Results showed that the patterns differ
significantly on a set of variables (see Table 1 for the descriptive statistics of these variables).
- Insert Table 1 about here -
First, there is a difference in the number of conflict events that are mentioned in the Family Doll Play (2 = 7.15, p < .05) and on the theory of mind total score (2 = 11.83, p <
.01). Regarding the behavior of the child, there is a difference in the CBCL total score (2 = 6.76, p < .05), which is mainly due to externalized symptoms (2 = 4.89, p = .08). Finally, regarding the observed behavior of the child, the results show that there is a difference in child autonomy in the PNG (2 = 9.93, p < .01; see Table 2).
- Insert Table 2 about here -
Specific contrasts were then performed4 and an effect size computed for each significant post hoc Mann-Whitney (r = Z/√N). For the number of conflict events in the Family Doll Play, the specific contrasts show that the difference is due to children of the high-to-low group mentioning significantly more events than children of the high stable group (effect size
.47, a medium effect according to Cohen’s standards; Cohen, 1988). Regarding theory of mind, children of the low stable group have a score that is significantly lower than that of children of the high stable group (r = .64, a large effect) and children of the high-to-low group (r = .47). For the CBCL total score, children of the high stable group have a significantly lower score than do children of the high-to-low group (r = .46). Finally, the contrasts regarding child autonomy in the PNG show that the high stable group has higher scores than the low stable group (r = .56, in the large effect range).
Interaction between patterns of family alliance and temperament
Because conflict in the Family Doll Play and the CBCL total score are predicted by both family alliance and temperament, we tested a possible interaction effect between these
variables. To this end, we split the sample according to the median successively for IBQ negativity, EAS emotionality, and sociability in order to obtain two groups: low and high, respectively, for each temperamental dimension. We then ran the analyses again separately for each group. Compared with the results presented earlier, this procedure showed that the CBCL total score is higher in children of the high stable group only for children of the high sociability group (2 = 8.3, p < .05); the number of conflict events mentioned in the Family Doll Play is higher in the high-to-low group only for children of the low sociability group (2
= 7.5, p < .05) and for children of the high emotionality group (2 = 6.5, p < .05). On the other hand, the results show that the link between the patterns of family alliance and these two child outcomes are the same regardless of the level of negativity.
DISCUSSION
The aim of this paper was to document the impact of the development of family alliance during the first 2 years on the emotional and cognitive development of children at age 5.
As presented in a previous paper (Favez, Frascarolo, & Fivaz-Depeursinge, 2006), a person-based approach has shown that families may be grouped according to three distinct patterns: the first pattern, high stable, represents families that are able to coordinate in the LTP from pregnancy to the end of the second year. The second pattern, low stable, represents families that have difficulty in coordinating in the LTP. Taken together, these families
represent 75% of our sample, which means that family alliance is fairly stable through time and so postnatal interactions may be anticipated to a certain extent from the coordination between parents playing with a pretend-to-be baby as early as in the second semester of pregnancy. However, for a small part of the families, the quality of alliance decreases sharply between 3 and 9 months; we labeled this evolution a high-to-low pattern. We have tested the extent to which these different evolutions are explained by the child’s own contribution, assessed in terms of temperament. We have found that sociability at 18 months is linked with the patterns, but this is the only link and it is of small magnitude. Moreover, most of the alliances are stable from pregnancy on, so that we can conclude that the characteristics of the children are not the main factor to explain the decrease of the alliance over time.
In order to test the effect of these patterns on the development of the child, we assessed two main categories of outcomes at age 5: affective development through the adaptive
behaviors of the child and the emotional themes in symbolic play, and cognitive development through the assessment of theory of mind and understanding of emotion.
Our first hypothesis was that children of high stable families would have better
outcomes than children of high-to-low and low stable families. The results partially confirm this hypothesis. There is indeed a difference between children of high stable and low stable families, first for cognitive outcomes: Children of high stable families obtain higher scores on theory of mind tasks. As we have developed elsewhere (Fivaz-Depeursinge & Favez, 2006), infants show very early competencies in interacting with several people at a time and also
show sensibility to emotional cues not only in direct interactions (when they are active
partners), but also when they are witnessing interactions between their parents. Differences in alliance may thus constitute differences in the context in which the child has opportunities to learn multiple perspectives and to understand other people’s mind: A low coordination
context does not offer as many opportunities to practice the sharing of affects with two people at a time, whereas a highly coordinated context may promote the perspective of others, as the child witnesses cooperation, negotiations, and resolved disagreements between parents (Ruffman et al., 2006). Interestingly, although these children seem to be more skillful at understanding other people’s perspectives, they also show more behavioral autonomy in the PNG: They are more able to play by themselves when they are not at the center of their parents’ attention. This finding is a process analogous to what has been described in securely attached children: Being at ease in close relationships is related to coping more easily when left alone and having to take care of oneself (Prior & Glaser, 2006).
Children of high stable families also have better affective outcomes than children of high-to-low families: The number of conflicts that they evoked in the Family Doll Play and their scores on the CBCL are lower. We can assume that these effects are due to the
worsening of the interactive coordination in the high-to-low families, which may reveal a progressive increase in the number of interparental disagreements and conflicts. This would, in turn, be responsible for behavior dysregulation in children (Cummings & Davies, 2010).
Indeed, mentioning conflicts in the Family Doll Play might reveal a more frequent exposure to conflicts for these children than for the children of the other two groups; as several studies have shown, interpersonal variables are linked to the memory of emotional events. For example, 3-year-old children who were assessed as insecurely attached to mothers (avoidant or ambivalent) during infancy have better memories of negative events in puppet shows than of positive events, whereas secure children have better memories of positive events (Belsky,
Spritz, & Crnic, 1996). Additional research is necessary to explain why this effect is true for high-to-low families only and not for low stable families (to what extent there are more conflicts in high-to-low families that may be due to disillusions of parental prebirth expectations regarding family life).
Our second hypothesis is also partially confirmed; children of the high-to-low group have better outcomes than do children of the low stable group, but for theory of mind tasks only, which tends to show that even transient exposure to an adjusted relational context may have a beneficial effect.
Finally, our third hypothesis postulated that marital satisfaction and temperament would also be linked to child outcomes. Surprisingly, this was not the case for marital satisfaction.
That may mean that the effect of marital dissatisfaction on children’s socio-affective
functioning is not direct, but mediated through interactive variables such as parental behaviors directed toward the child or to the other parent (the coparental interactions), so that a covert dissatisfaction (nevertheless revealed in the questionnaire) may not impact the development of the child. Additional research is needed to confirm this hypothesis, for example, by including in the procedure an observational assessment of the couple during a joint problem- solving task.
Regarding temperament, our results show that negativity at 3 months and emotionality and sociability at 18 months are linked with the affective themes in the Family Doll Play and with the different measures of the CBCL. Moreover, we found a possible interaction effect between temperament at 18 months and patterns of family alliance, showing that the impact of family relations may be exerted differentially according to the personality of the child. This speaks to a composite picture of the variables that influence development and urges clinicians and researchers in the field of family therapy not to forget children’s own contribution to possible developmental disturbances (see Crouter & Booth, 2003). An “easy” child would, for
example, be more easily self-regulated so that interactions with others would be easier to coordinate, which would in turn help the child to regulate herself even more easily; on the other hand, a child with low self-regulation skills would be more difficult to manage, putting interactions with others under strain, which would in turn decrease the quality of external regulation that the environment can provide to the child.
Several clinical implications may be drawn from these results. The first is that when there are tensions in the couple during pregnancy, it is likely that family interactions will also be difficult once the baby is born and that the development of the child will be affected even several years later. This calls for preventive interventions, as there does not seem to be a
“natural” increase in the quality of family interactions after the birth of the baby; in other words, the baby does not heal the relationships between the parents, but may be entrapped in the parental conflict, as Minuchin (1974) has described. The second clinical implication is the importance of taking into account individual as well as interpersonal variables; indeed, our data show that the child’s temperament explains part of their own development. This means that some families may present cumulative risks in the transition to parenthood, so that couple and family therapists should be sensitive to the multifactorial origins of family developmental disturbances. Finally, our results show the possibility of using the family alliance model as an evaluation tool to set up tailored interventions; our practice has shown, for example, that difficulties in the participation function are related to more serious disturbances than are difficulties in the other functions and thus need more intensive therapies (Favez et al., 2009;
see Frascarolo & Favez, 2009, for an example of intervention that targets family alliance).
However, some major limitations of this study have to be mentioned, the most obvious being sample size. We lacked sufficient statistical power to perform multivariate analyses that would have been necessary to test mediation or moderation effects between the variables of different levels: individual (temperament), dyadic (marital satisfaction), and triadic (family
alliance). Another limitation lies in the instruments we used, which are parent-reported questionnaires; for example, it might be the case that parents in conflict see the temperament of their child more negatively than is demonstrated by the child’s actual behavior. Further data are thus necessary, with a larger sample size and additional methodology such as
“outsider” reports (e.g., a teacher or pediatrician). Despite these limitations, our results are a first step in the demonstration of the impact of a family-level variable—the family alliance—
on the development of 5-year-olds. This confirmed our hypothesis that different alliances constitute different contexts of development, which are more or less optimal for the development of emotional regulation and understanding of inner states.
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Footnotes
1 The previous version of the GETCEF coding system does not include the affect sharing dimension.
2 Two of the 118 items, asthma and allergies, are not taken into account in the total.
3The distribution differs slightly from the one in the 2006 article, as three families dropped out of the study when the child was between 18 months and 5 years, and three others who completed the protocol in the meantime were added to the sample.
4 In accordance with Bonferroni’s correction, the usual level of significance (.05) was divided by the number of comparisons made (three) for each variable. The significance level was thus set at .016.
-2 -1.5 -1 -0.5 0 0.5 1
Prenatal 3 months 9 months 18 months
Alliance Z-scores
High stable Low stable High to low
Figure 1. The Three Patterns of Family Alliance Evolution From Pregnancy to 18 Months After Birth
Table 1
Means and Standard Deviations for the Main Child Outcomes at Age 5 for the Three Patterns of Family Alliance
Patterns of family alliance Outcome variables Total
High stable (N = 19)
High to low (N = 10)
Low stable (N = 9) Family Doll Play
Conflict 0.72 (1.05) 0.08 (0.26) 1.36 (1.79) 0.73 (1.09) Theory of mind
Total score 4.71 (1.91) 5.86 (1.86) 5.60 (2.46) 2.67 (1.41) Child Behavior Checklist
Total score 37.20 (11.51) 30.89 (11.31) 44.50 (12.72) 36.22 (10.50) PicNic Game
Child autonomy 3.27 (1.17) 4.06 (1.03) 3.30 (1.34) 2.44 (1.13)
Table 2
Differences, Specific Contrasts, and Effect Sizes Between Family Alliance Patterns for the Main Child Outcomes
Specific contrasts between patterns (Mann-Whitney U and effect sizes) Outcome variables Kruskal-
Wallis
High stable/Low stable
High stable/High to low
Low stable/High to low
FDP conflict 7.2* — 54.0, r = .47 —
Theory of mind 11.8** 16.5, r = .64 - 15.0, r = .47
CBCL total score 6.8* — 41.5, r = .46 —
PNG child autonomy 9.9** 23.5, r = .56 — —
Note. Dashes indicate that the contrast is not significant. CBCL = Child Behavior Checklist; FDP = Family Doll Play; PNG = PicNic Game.
All Mann-Whitney U’s significant at p < .016 ; r = effect sizes.
*p < .05, **p < .01.
