At the outset of this part of this study a number of hypotheses were made which proposed that the quality of attachment and family functioning between a group of children with cystic fibrosis and a control group would be quantifiably different. It was predicted that the cystic fibrosis group would be more likely to be classified as 'insecure' and that they would have different patterns of family functioning.
Part 4: Discussion for the Cystic Fibrosis Study
12.2 Limitations of this Study
There are a number of limitations to this part of the study which are additional to the ones outlined in the previous section. Firstly, it was ambitious to be developing a measure whilst at the same time using it as a test, as the measure had yet to be validated.
Secondly, employing discriminant measures of validity, such as the CBCL and a shortened form of the WISC, with this group would have been useful, especially in being able to control for psychological disturbance. However, some have argued that the CBCL is inappropriate to use with children with chronic illness as scores can be artificially inflated due to inherent health problems (Perrin, Stein, and Doctar, 1991) and was not feasible within the acceptable protocol for this sample.
Thirdly, it not possible to argue fi'om insignificant findings due to lack of power with this study. At the outset it was anticipated that the effect size between the treatment and control groups would be large (.80). There would be 80% power to detect a difference between a normal group where the proportion of security is 60% and a cystic fibrosis group where the proportion of security is 30% where the sample size in each group is 40. Within the time restraints of this project, it was not possible to interview 40 children for each group.
Part 4: Discussion for the Cystic Fibrosis Study
12.3 The Childhood Attachment Interview
CAI Main Classifications
Within the cystic fibrosis sample there was a greater number of “insecure” than “secure” classifications for mother and father respectively. Furthermore, there were three children who were classified as “secure” with mother but “insecure” with father. This demonstrates that the classification to mother compared to father is independent of one another for a small number of children. This observation is in keeping with previous studies which report that there is no correlation between the pattern of attachment with mother and father (Main and Westen, 1981; Fox et al., 1991).
The only significant finding when comparing main classifications was that children with cystic fibrosis were more likely to be classified as “insecure” with respect to their fathers compared with the children fi'om the control group This observation needs to be interpreted with caution due to the limitations of the study outlined above. However, such a finding would suggest at least three possible explanations.
First, this is a spurious finding. This suggestion is a possibility but it could be argued that the strength of the finding was well within conventional limits (p=.024); was predicted at the outset of the study; and was one of only two planned tests (Chi-squared tests for classification to mother and father respectively).
Part 4: Discussion for the Cystic Fibrosis Study
Second, there is a greater number of “insecure” classifications between children with cystic fibrosis and their fathers than with their mothers. Such a conjecture would not be in keeping with previous studies (Main and Westen, 1981; Fox et al., 1991) which have reported the distribution of attachment categories across mother and father groups is the same. Furthermore, it is not possible to argue fi'om this finding that children with cystic fibrosis are more likely to be “insecure” with respect to attachment to their fathers than to their mothers, as one cannot argue from insignificant findings.
Third, there is greater proportion of “insecure” classifications, to both mother and father, for children with cystic fibrosis compared to children without cystic fibrosis. It could be argued that this study only observed this difference for fathers and not mothers due the small sample size; This premise would be in keeping with studies that have observed a greater proportion of “insecure” infants with cystic fibrosis when compared with health controls (Goldberg, et al. 1995; Simmons et al, 1995). To establish if this speculation is well founded, it would be necessary to extend this study to include more children in both the cystic fibrosis and control groups.
If this were found to be the case, the means by which insecurity is passed on inter- generationally from mother-to-child and father-to-child may be different. Mothers are generally the principal caregivers and the ones who become more involved with their children’s treatment from the outset (Angst, 1997; Bryon, 1998). This involvement could lead to a preoccupation with the physical care of their child, at the expense of
Part 4: Discussion for the Cystic Fibrosis Study
emotional availability. Alternatively, fathers of children with cystic fibrosis may feel more shut out of their children’s lives than the fathers of children without cystic fibrosis and thereby distance themselves fi'om their children (Angst, 1997).
However, it is unlikely that patterns of attachment are passed on purely behaviourally. For example, previous studies have shown there in an association between the mothers’
state of mind (italics mine) with respect to attachment prepartum and infants’ subsequent attachment classification in a standardised laboratory procedure (Fonagy et al., 1991). It is more likely, that some parents’ states of mind with respect to attachment are affected upon hearing the news that their child has cystic fibrosis which then affects the nature of the parent-child interaction. Such a model would also offer an explanation for the inter- generational transmission of secure attachment patterns...
CAI Scales
There were no statistical difference between the cystic fibrosis and control groups on any of the scales. However, on all the scales the cystic fibrosis group had mean scores that were towards the pole of insecurity compared with the normal group’s scores coupled with higher standard deviations. This could be explained by the presence of a larger “insecure” type group within the cystic fibrosis sample.
Part 4: Discussion for the Cystic Fibrosis Study
12.4 The Separation Anxiety Test
No statistical significance was attained between the cystic fibrosis and normal groups on this measure. This could mean that there are no significant differences between the two groups on attachment security as assigned by the SAT coding system. However, as outlined earlier it is not possible to argue fi’om insignificant findings when the sample size is too small.
It is of interest to note that there are twice as many insecure children in the cystic fibrosis group compared with the normal group. Furthermore, only the cystic fibrosis group contained type responses (“E l”=4; “E2”=3). These responses identified passivity and angry/conflicted responses. It is difficult to comment as to whether this is of any significance given the relatively small numbers in each group. Upon reflection it would have been usefiil to conduct an sub-classification analysis across group where the sub classification were reduced to “secure”, “insecure-dismissing” and “insecure-conflicted”.