Empathy and Parental Sensitivity in Child Attachment and Socioemotional Development: A Systematic Review from Emotional, Genetic, and Neurobiological Perspectives
Abstract
1. Introduction
2. Materials and Methods
2.1. Search Strategy
(maternal sensitivity or parental sensitivity or caregiver sensitivity) AND (attachment theory or attachment or attachment style) AND empathy
2.2. Eligibility Criteria
2.3. Study Selection
2.4. Data Extraction and Quality Assessment
3. Results
4. Discussion
4.1. Limitations
4.2. Practical Implications and Intervention Recommendations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study | Design | Sample | Measures | Key Findings |
---|---|---|---|---|
Borelli et al. [17] (2016) | Cross-sectional correlational | 60 dyads (USA) | Parental development interview (PDI-R-SC); PACES (Parental Affective and Cognitive Empathy Scale); dispositional empathy questionnaire (self-report by the parent); child attachment interview (CAI); child perception of parental warmth (derived from CAI); caregiver’s attachment style: adult self-report. | Parental empathy correlated with attachment security (r = 0.42, p < 0.01) and emotional openness (r = 0.38, p < 0.05). |
Butcher et al. [18] (1993) | Longitudinal | Mothers of premature infants (unspecified) | Maternal rigidity, sensitivity, attachment, and infant responsiveness. | Maternal rigidity predicted lower sensitivity and insecure attachment (p < 0.05). |
Chase et al. [19] (2014) | Cross-sectional Neurobiological | 37 mothers (USA) | Neural connectivity (fMRI), Hamilton depression rating scale (HDRS), Edinburgh postnatal depression Scale (EPDS), and parent-to-infant attachment questionnaire. | Mothers with postpartum depression exhibited abnormal connectivity between the PCC (central region of the default mode network) and the right amygdala; in the depressed group, the PCC–amygdala showed negative coupling (inverse correlation), while this inverse coupling was not observed in healthy mothers. PCC–amygdala connectivity was positively correlated with PCC–parahippocampal connectivity in the overall group. |
Javakhishvili and Vazsonyi [20] (2022) | Longitudinal | 1364 children and their families (USA) | Maternal sensitivity; HOME inventory; strange situation; EITQ; WASI; SSRS; youth psychopathic trait inventory; self-reported delinquency. | Early positive socialization predicted higher empathy (β = 0.15) and self-control (β = 0.25) and lower emotional insensitivity (β = −0.16, p = 0.038) and delinquency (β = −0.22, p = 0.041). |
Kaźmierczak et al. [21] (2024) | Experimental | 221 heterosexual couples | Empathy (IRI); sensitivity; cry response (Ainsworth’s sensitivity). | Higher dispositional empathy was significantly associated with greater sensitivity in infant care (r = 0.48, p < 0.001). High personal distress was negatively correlated with sensitivity (r = −35, p < 0.05). |
Leerkes [22] (2010) | Longitudinal correlational | 101 mother-infant dyads (USA) | Maternal emotional reactions to crying questionnaire, emotional goal interview related to crying, maternal self-efficacy scale (adapted), CES-D (Center for Epidemiologic Studies Depression Scale), and infant distress detection measure (using video clips). | Maternal sensitivity correlated with empathy towards infant crying (r = 0.32, p < 0.05). High empathy and infant-oriented goals buffer the negative impact of infant distress on maternal sensitivity. |
Leerkes et al. [23] (2017) | Longitudinal and genetic | 207 mothers (USA) | Maternal genotypes (vasopressin receptor AVPR1a and dopamine receptor DRD4 (long vs. short allele), cry processing, Ainsworth’s Maternal Sensitivity Scale, and adult attachment interview (AAI). | Infant-oriented processing was associated with greater maternal sensitivity: B = 0.26, SE = 0.11, β = 0.13, and p < 0.05. Coherence of mind and maternal education were significant predictors of greater maternal sensitivity. AVPR1a and DRD4 were associated with a greater focus on the mother’s own needs, which in turn reduced maternal sensitivity. |
Ma et al. [24] (2017) | Experimental cross-sectional | 65 women (China) | Attachment styles (ECR); brain activity (ERP); emotional processing. | N170: no significant differences in amplitude by attachment style. P300: Securely attached women showed higher P300 amplitudes for infant faces (~7.6 µV vs. ~5.3 µV in avoidant; p ≈ 0.04). In response to infant crying, both secure and anxious groups had higher P300 amplitudes than the avoidant group (p = 0.018–0.005; p = 0.013). Avoidant women had the lowest P300 responses, showing minimal differentiation between crying and neutral faces, suggesting reduced engagement with infant cues. |
Marakovitz [25] (2001) | Longitudinal | 111 dyads (USA) | Child empathy: Evaluated 24 and 36 months in the laboratory through “harm simulation” scenarios; child temperament; maternal sensitivity: Observed in semi-structured interactions at 6, 15, and 24 months and rated on scales (e.g., Ainsworth sensitivity); strange situation. | Maternal sensitivity correlated with empathic concern (r = 0.24, p < 0.01). |
Musser et al. [26] (2012) | Cross-sectional correlational | 22 mothers (USA) | Maternal sensitivity; brain activity (fMRI); intrusiveness; dyadic harmony. | Maternal sensitivity correlated with prefrontal activation (p < 0.05), specifically the right frontal pole and right inferior frontal gyrus (orbitofrontal/inferior cortex). Conversely, mothers with more intrusive behavior showed significantly greater activation in the left anterior insula and temporal pole when hearing their own infant’s cry. |
Nieri [27] (2017) | Cross-sectional | 118 fathers (Argentina) | Paternal sensitivity questionnaire, big five inventory (BFI)reactive interpersonal index (IRI; Spanish adaptation)relationship questionnaire (Spanish adaptation). | Paternal sensitivity correlated with secure attachment (r = 0.25, p < 0.01). For fathers aged 18–25, avoidant attachment was negatively correlated with sensitivity (r = −0.84, p < 0.01). Personal distress was linked to lower empathy in negative situations (r = −0.43, p < 0.01). For fathers aged 31–50, secure attachment was weakly correlated with sensitivity (r = 0.21, p < 0.05). Higher sensitivity was related to greater empathy, especially in perspective-taking and lower personal distress. Fathers in stable relationships showed higher sensitivity, empathy, and secure attachment, while separated fathers tended to develop fearful behaviors. |
Pederson et al. [28] (2014) | Longitudinal | 64 mother–infant dyads (Canada) | Maternal sensitivity (Q-set); infant attachment (strange situation); relational harmony. | Maternal sensitivity correlated with infant attachment (r = 0.45, p < 0.001). |
Pillai et al. [29] (2011) | Longitudinal | 731 dyads (Canada) | Caregiver sensitivity (emotional availability scales); infant pain behavior (NFCS). | Caregiver sensitivity showed significant stability over time: Sensitivity at 2, 4, 6, and 12 months was autocorrelated (e.g., 6→12 months β = 0.62, p < 0.001). At 12 months, a significant association emerged: more sensitive caregivers had infants with fewer prolonged pain expressions after vaccination (residual correlation with NFCS at 1 min: r = −0.39, p < 0.001). At 2, 4, and 6 months, the concurrent correlation between sensitivity and pain response was not significant. |
Stevenson-Hinde et al. [30] (2013) | Cross-sectional | 98 mothers (UK/Netherlands) | Maternal anxiety (HADS); maternal sensitivity; infant attachment (modified strange situation). | Maternal anxiety reduced sensitivity (β = −0.34) and indirectly affected attachment. Sensitivity explained 33% of attachment security variance (β = 0.58, p < 0.001). |
Van der Mark et al. [31] (2002) | Longitudinal | 125 girls and their mothers (Netherlands) | Child empathy (observed); child temperament (fear); maternal sensitivity; strange situation; Bayley scales of infant development. | Attachment security and maternal sensitivity did not show significant correlations with empathy in most cases. In regression analyses, low attachment security (β ≈ 0.19, p = 0.04) and higher child fear (β ≈ −0.20, p = 0.02) predicted lower empathy toward the stranger at 22 months. Paradoxically, higher concurrent maternal sensitivity was associated with lower child empathy toward the stranger (r = −0.24, p < 0.01). |
Study | Design | Risk of Bias |
---|---|---|
Borelli et al. [17] (2016) | Cross-sectional and Experimental | Moderate risk: Cross-sectional design limits causal inferences. |
Butcher et al. [18] (1993) | Longitudinal | Low risk: Longitudinal design, well-characterized sample. |
Chase et al. [19] (2014) | Cross-sectional and Neurobiological | Moderate risk: Small sample, cross-sectional design. |
Javakhishvili and Vazsonyi [20] (2022) | Longitudinal and Neurobiological | Low risk: Robust design, genetic and neurobiological evaluation. |
Kaźmierczak et al. [21] (2024) | Longitudinal | Low risk: Large sample, robust design, multiple standardized measures. |
Leerkes [22] (2010) | Experimental | Moderate risk: Experimental design, small sample. |
Leerkes et al. [23] (2017) | Longitudinal | Low risk: Longitudinal evaluation and direct observation. |
Ma et al. [24] (2017) | Longitudinal and Genetic | Low risk: Robust design, genetic evaluation, and direct observation. |
Marakovitz [25] (2001) | Neurocognitive | Low risk: Experimental design, neurocognitive evaluation. |
Musser et al. [26] (2012) | Longitudinal | Low risk: Well-characterized sample, longitudinal evaluation. |
Nieri [27] (2017) | Neurocognitive | Moderate risk: Small sample, cross-sectional design. |
Pederson et al. [28] (2014) | Cross-sectional | Moderate risk: Cross-sectional design limits causal inferences. |
Pillai et al. [29] (2011) | Longitudinal | Low risk: Use of MBQS and the strange situation procedure, well-characterized sample. |
Stevenson-Hinde et al. [30] (2013) | Longitudinal | Low risk: Large sample, longitudinal evaluation. |
Van der Mark et al. [31] (2002) | Longitudinal | Low risk: Well-characterized sample, longitudinal evaluation. |
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Santana-Ferrándiz, M.; Ibáñez-Pérez, J.; Moret-Tatay, C. Empathy and Parental Sensitivity in Child Attachment and Socioemotional Development: A Systematic Review from Emotional, Genetic, and Neurobiological Perspectives. Children 2025, 12, 465. https://doi.org/10.3390/children12040465
Santana-Ferrándiz M, Ibáñez-Pérez J, Moret-Tatay C. Empathy and Parental Sensitivity in Child Attachment and Socioemotional Development: A Systematic Review from Emotional, Genetic, and Neurobiological Perspectives. Children. 2025; 12(4):465. https://doi.org/10.3390/children12040465
Chicago/Turabian StyleSantana-Ferrándiz, Miriam, Jesús Ibáñez-Pérez, and Carmen Moret-Tatay. 2025. "Empathy and Parental Sensitivity in Child Attachment and Socioemotional Development: A Systematic Review from Emotional, Genetic, and Neurobiological Perspectives" Children 12, no. 4: 465. https://doi.org/10.3390/children12040465
APA StyleSantana-Ferrándiz, M., Ibáñez-Pérez, J., & Moret-Tatay, C. (2025). Empathy and Parental Sensitivity in Child Attachment and Socioemotional Development: A Systematic Review from Emotional, Genetic, and Neurobiological Perspectives. Children, 12(4), 465. https://doi.org/10.3390/children12040465