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


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.

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Available from: Fred Rogosch, Jul 11, 2014
    • "These unsettling, confusing exchanges leave the baby with no clear way to organize a response to distress. The percentage of those classified as having disorganized attachment ranges from 13% in nonclinical samples to 90% in samples of maltreated children (Cicchetti, Rogosch, & Toth, 2006;Lyons-Ruth & Jacobvitz, 2008). Disorganized attachment is more prominent in dyads in which the parent has a history of unresolved loss or trauma in his or her own childhood (Hesse & Main, 1999) or where there is a history of child maltreatment. "
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    ABSTRACT: This clinical case study explores the integration of infancy research, brain development, attachment theory, and models of infant-parent/child-parent psychotherapy to address the needs of abused and neglected young children placed in foster or adoptive homes. Traumatized children employ defensive strategies to survive when there is no "good enough" caregiver (D.W. Winnicott, , p. 94), and helping professionals can provide therapeutic experiences to develop or restore a child's sense of safety. With the case example of Anthony and his foster/adoptive parents, I illustrate how to manage and contain a traumatized child's terror, rage, and grief through therapeutic sessions with the parent and child together, and supportive parental guidance. I promote attention to the child's ability to self-integrate and to regulate his own affect, and encourages secure-base parental responses that facilitate a child's shift toward secure attachment behavior.
    No preview · Article · Dec 2015 · Infant Mental Health Journal
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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.
    Full-text · Article · Jan 2015 · Family Process
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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.
    Full-text · Article · Oct 2014 · Journal of Child Psychology and Psychiatry
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