Fostering secure attachments in infants in maltreating families through preventive interventions. Development and Psychopathology, 18, 623-649

University of Rochester, Rochester, New York, United States
Development and Psychopathology (Impact Factor: 4.89). 02/2006; 18(3):623-49. DOI: 10.1017/S0954579406060329
Source: PubMed

ABSTRACT The malleability of insecure and disorganized attachment among infants from maltreating families was investigated through a randomized preventive intervention trial. Findings from research on the effects of maltreatment on infant attachment were incorporated into the design and evaluation of the intervention. One-year-old infants from maltreating families (N = 137) and their mothers were randomly assigned to one of three intervention conditions: (a) infant-parent psychotherapy (IPP), (b) psychoeducational parenting intervention (PPI), and (c) community standard (CS) controls. A fourth group of infants from nonmaltreating families (N = 52) and their mothers served as an additional low-income normative comparison (NC) group. At baseline, mothers in the maltreatment group, relative to the nonmaltreatment group mothers, reported greater abuse and neglect in their own childhoods, more insecure relationships with their own mothers, more maladaptive parenting attitudes, more parenting stress, and lower family support, and they were observed to evince lower maternal sensitivity. Infants in the maltreatment groups had significantly higher rates of disorganized attachment than infants in the NC group. At postintervention follow-up at age 26 months, children in the IPP and PPI groups demonstrated substantial increases in secure attachment, whereas increases in secure attachment were not found for the CS and NC groups. Moreover, disorganized attachment continued to predominate in the CS group. These results were maintained when intent to treat analyses were conducted. The findings are discussed in terms of the utility of translating basic research into the design and evaluation of clinical trials, as well as the importance of preventive interventions for altering attachment organization and promoting an adaptive developmental course for infants in maltreating families.

    • "This places the infant in a para - doxical situation in which the person who should provide a secure base and to whom the infant instinctively turns to for comfort and protection at times of stress becomes a source of stress ( Hesse & Main , 2006 ; Madigan , Voci , & Benoit , 2011 ) . While the rate of infant attachment disorganization in nonclinical , middle - class samples is relatively low ( 15% ) ( van Ijzendoorn , Schuengel , & Bakermans - Kranenburg , 1999 ) , very high rates have been reported in maltreated infants ( 77 – 90% ) ( Barnett , Ganiban , & Cicchetti , 1999 ; Carlson , Cicchetti , Barnett , & Braunwald , 1989 ; Cicchetti , Rogosch , & Toth , 2006 ; van IJzendoorn , 1995 ) . However , little is known concerning the prevalence of disorganized attachment re - lationships in infants of parents with CA&N , versus infants who themselves have experienced abuse or neglect . "
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    ABSTRACT: There are still important gaps in our knowledge regarding the intergenerational transmission of attachment from mother to child, especially in mothers with childhood histories of abuse and neglect (CA&N). This study examined the contributions of reflective function concerning general attachment relationships, and specifically concerning trauma, as well as those of maternal attachment states of mind to the prediction of infant attachment disorganization in a sample of mothers with CA&N and their infants, using a 20-month follow-up design. Attachment and reflective functioning were assessed during pregnancy with the Adult Attachment Interview. Infant attachment was evaluated with the Strange Situation Procedure. The majority (83%) of infants of abused and neglected mothers were classified as insecure, and a significant proportion (44%) manifested attachment disorganization. There was a strong concordance between mother and child attachment, indicative of intergenerational transmission of attachment in parents with CA&N and their infants. Both unresolved trauma and trauma-specific reflective function made significant contributions to explaining variance in infant attachment disorganization. The findings of this study highlight the importance of trauma-specific mentalization in the intergenerational transmission of attachment by mothers with a history of childhood maltreatment, and provide new evidence of the importance of the absence of mentalization regarding trauma for infant attachment. © 2015 Michigan Association for Infant Mental Health.
    Infant Mental Health Journal 02/2015; 36(2). DOI:10.1002/imhj.21499 · 0.61 Impact Factor
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    • "FAMILY PROCESS parent-directed treatment component are also empirically supported (March, Amaya- Jackson, Murray, & Schulte, 1998). Among families with intimate partner violence, several studies have documented that child–parent psychotherapy is effective in reducing child and mother PTSD symptoms, as well as other behavioral problem outcomes (Lieberman, Ghosh Ippen, & Van Horn, 2006; Lieberman, Van Horn, & Ghosh Ippen, 2005; Toth, Rogosch, Manly, & Cicchetti, 2006). In addition, there is a version for toddlers that focuses on improving the parent–child relationship and fostering secure attachments (Toth et al., 2006). "
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    ABSTRACT: Child maltreatment is widespread and has a tremendous impact on child victims and their families. Over the past decade, definitions of child maltreatment have been developed that are operationalized, face valid, and can be reliably applied in clinical settings. These definitions have informed the revised Diagnostic and Statistical Manual (American Psychiatric Association, 2013) and are being considered for the International Classification of Disease–11 (World Health Organization). Now that these definitions are available in major diagnostic systems, primary healthcare providers and clinicians who see children and families are poised to help screen for, identify, prevent, and treat child maltreatment. This article reviews the definitions of maltreatment in these diagnostic systems, along with assessment and screening tools, and empirically supported prevention and intervention approaches.El maltrato infantil es muy común y tiene un efecto tremendo en los niños que lo sufren y en sus familias. Durante la última década, se han elaborado definiciones de maltrato infantil que están en uso, son legítimas, y pueden aplicarse confiablemente en entornos clínicos. Estas definiciones se han incorporado en la edición revisada del Manual diagnóstico y estadístico de los trastornos mentales (DSM-5; Asociación Estadounidense de Psiquiatría, 2013) y se está considerando su inclusión en la Clasificación internacional de enfermedades – 11 (Organización Mundial de la Salud). Ahora que estas definiciones están disponibles en los sistemas de diagnóstico más importantes, los profesionales de la salud dedicados a la atención primaria así como los pediatras y los médicos de familia están preparados para ayudar a detectar, identificar, prevenir y tratar el maltrato infantil. En este artículo se analizan las definiciones de maltrato en estos sistemas de diagnóstico junto con las herramientas de evaluación y detección, así como los enfoques de intervención y prevención respaldados empíricamente.儿童虐待很普遍,并且对儿童受害者及其家庭有重大影响。在过去的10年中,一些投入运作的,面部有效并能够可靠地运用于临床的关于儿童虐待的定义被发展起来。这些定义被纳入修改后的诊断和统计手册(DSM-5; 美国精神科协会,2013),并被考虑纳入国际疾病分类-11(世界卫生组织)。现在这些定义已经用于主要诊断系统,基层医疗健康提供者和儿童及家庭临床医师们 已准备好帮助进行筛查,识别,预防和治疗儿童虐待问题。本文回顾了在这些诊断系统中虐待的定义,评估和筛查工具,以及有实证支持的预防和干预措施。
    Family Process 01/2015; 54(1). DOI:10.1111/famp.12131 · 1.73 Impact Factor
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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 · 5.67 Impact Factor
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