Enhancing Attachment Organization Among Maltreated Children: Results of a Randomized Clinical Trial

Department of Psychology, University of Delaware, Newark, DE 19716, USA.
Child Development (Impact Factor: 4.92). 01/2012; 83(2):623-36. DOI: 10.1111/j.1467-8624.2011.01712.x
Source: PubMed


Young children who have experienced early adversity are at risk for developing disorganized attachments. The efficacy of Attachment and Biobehavioral Catch-up (ABC), an intervention targeting nurturing care among parents identified as being at risk for neglecting their young children, was evaluated through a randomized clinical trial. Attachment quality was assessed in the Strange Situation for 120 children between 11.7 and 31.9 months of age (M = 19.1, SD = 5.5). Children in the ABC intervention showed significantly lower rates of disorganized attachment (32%) and higher rates of secure attachment (52%) relative to the control intervention (57% and 33%, respectively). These results support the efficacy of the ABC intervention in enhancing attachment quality among parents at high risk for maltreatment.

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Available from: Erin Lewis-Morrarty, Jan 29, 2015
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    • "Interactions between the caregiver and the child are videotaped; the caregiver and assigned parent coach review the footage and discuss strengths and barriers, which allows the caregiver to learn how to interact in a sensitive manner with their foster child to increase their attachment security (Dozier, Dozier and Manni, 2002). Evaluation of this intervention found that foster and at-risk parents can be taught and coached on how to be sensitive parents and that this can, in turn, affect their children's regulatory and attachment systems in a positive way (Bernard, et al., 2012; Dozier, et al., 2006). "
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    ABSTRACT: It is well established that looked after children are more likely to develop complex behavioural and emotional difficulties that can leave many carers struggling to help and understand the child. This can lead to the breakdown of placements whereby the lack of placement stability leaves the child even more vulnerable. The Family Minds (FM) psycho-educational and interactive programme is a newly developed intervention for groups of foster and adoptive parents. It lasts for nine hours and comprises elements of mentalisation-based family therapy, lectures, group exercises and homework, with the aim that parents will be able to better understand and support their fostered or adopted child through increased reflective functioning. In a study undertaken in Texas we evaluated whether there was a change in the parents’ reflective functioning (verbal mentalisation) pre- to post-FM training compared to a comparison group who experienced a ‘treatment as usual’ intervention comprising four hours of lecture information about trauma and attachment. Using five-minute speech samples pre- and post-training, we coded whether the capacity to think reflectively about oneself and one’s child altered in either training group. We found that, unlike the comparison group, parents in the FM group significantly increased their reflective functioning. This outcome was independent of several factors such as the age of the parent, age of the child and time as a carer. The only factor influencing the significant change was the training group in which the parent was placed. These findings suggest that this novel mentalisation-based psycho-educational training programme can successfully increase parents’ reflective functioning which, in turn, should enhance and strengthen the understanding and relationship between the foster/adoptive parent and the child and reduce negative outcomes.
    03/2015; 39(1):38-50. DOI:10.1177/0308575914565069
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    • "That is, sensitive and responsive care, in which the parent identifies and responds to the child's needs. Evidenced based interventions with maltreated children have been shown to enhance attachment and should be attempted with children with DSED (Bernard et al., 2012; Cicchetti, Rogosch, & Toth, 2006). Although adequate caregiving seems both to prevent and to ameliorate DSED, the persistence of signs of DSED in some children indicates that additional strategies and approaches beyond an enhancement of caregiving are needed. "
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    ABSTRACT: Background Though noted in the clinical literature for more than 50 years, attachment disorders have been studied systematically only recently. In part because of the ubiquity of attachments in humans, determining when aberrant behavior is best explained as an attachment disorder as opposed to insecure attachment has led to some confusion. In this selective review, we consider the literature on reactive attachment disorder and disinhibited social engagement disorder and describe an emerging consensus about a number of issues, while also noting some areas of controversy and others where we lack clear answers. We include a brief history of the classification of the disorders, as well as measurement issues. We describe their clinical presentation, causes and vulnerability factors, and clinical correlates, including the relation of disorders to secure and insecure attachment classifications. We also review what little is known and what more we need to learn about interventions.Methods We conducted a literature search using PubMed, PsycINFO, and Cochrane Library databases, using search terms ‘reactive attachment disorder,’ ‘attachment disorder,’ ‘indiscriminate behavior,’ ‘indiscriminate friendliness,’ ‘indiscriminate socially disinhibited reactive attachment disorder,’ ‘disinhibited social engagement disorder,’ and ‘disinhibited social behavior.’ We also contacted investigators who have published on these topics.FindingsA growing literature has assessed behaviors in children who have experienced various types of adverse caregiving environments reflecting signs of putative attachment disorders, though fewer studies have investigated categorically defined attachment disorders. The evidence for two separate disorders is considerable, with reactive attachment disorder indicating children who lack attachments despite the developmental capacity to form them, and disinhibited social engagement disorder indicating children who lack developmentally appropriate reticence with unfamiliar adults and who violate socially sanctioned boundaries.Conclusions Although many questions remain to be answered, especially regarding appropriate interventions, we know considerably more about attachment disorders than we did only a decade ago.
    Journal of Child Psychology and Psychiatry 10/2014; 56(3). DOI:10.1111/jcpp.12347 · 6.46 Impact Factor
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    • "Home-based programs have been shown to be effective with various populations of SNC. The children served by these programs range from children who have been maltreated (e.g., Bernard et al., 2012) to toddlers who show moderate behavioral difficulties (van Zeijl et al., 2006), but currently there are very few programs that address the needs of children who display very severe behaviors and that have been found to be effective across environments and age ranges. The need for effective programs to help the most at-risk children has been long-standing within the mental health community , a need that has far-reaching implications for the children, families, and society as a whole. "
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    ABSTRACT: Research on the effects of abuse, neglect, and other traumas in early childhood has consistently demonstrated severe deficits that can be prevalent across the life span. Costs associated with addressing such deficits in special-needs children can strain families and are an immense financial burden to society. Trust-Based Relational Intervention (R) is an intervention modality that targets the attachment system as part of a dynamic system of development. Presented is a summary of the costs of addressing the sequelae of childhood abuse and neglect, a brief overview of Trust-Based Relational Intervention, and a case study demonstrating the efficacy of this intervention with an adopted special-needs child in a home-based setting.
    Journal of Aggression Maltreatment & Trauma 08/2014; 23(6):633-651. DOI:10.1080/10926771.2014.920454
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