Decreasing rates of disorganised attachment in infants and young children, who are at risk of developing, or who already have disorganised attachment. A systematic review and meta-analysis of early parenting interventions

Abstract

BackgroundDisorganised attachment patterns in infants have been linked to later psychopathology. Services have variable practices for identifying and providing interventions for families of children with disorganised attachment patterns, which is the attachment pattern leading to most future psychopathology. Several recent government reports have highlighted the need for better parenting interventions in at risk groups.ObjectivesThe objective of this review and meta-analysis was to evaluate the clinical effectiveness of available parenting interventions for families of children at high risk of developing, or already showing, a disorganised pattern of attachment.MethodsPopulation: Studies were included if they involved parents or caregivers of young children with a mean age under 13 years who had a disorganised classification of attachment or were identified as at high risk of developing such problems.Included interventions were aimed at parents or caregivers (e.g. foster carers) seeking to improve attachment.Comparators included an alternative intervention, an attention control, treatment as usual or no intervention.The primary outcome was a disorganised pattern in childhood measured using a validated attachment instrument.Studies that did not use a true Randomised Controlled Trial (RCT) design were excluded from the review. Both published and unpublished papers were included, there were no restrictions on years since publication and foreign language papers were included where translation services could be accessed within necessary timescales.ResultsA comprehensive search of relevant databases yielded 15,298 papers. This paper reports a systematic review as part of an NIHR HTA study identifying studies pre-2012, updated to include all papers to October 2016. Two independent reviewers undertook two stage screening and data extraction of the included studies at all stages. A Cochrane quality assessment was carried out to assess the risk of bias. In total, fourteen studies were included in the review. In a meta-analysis of these fourteen studies the interventions saw less disorganised attachment at outcome compared to the control (OR = 0.50, (0.32, 0.77), p = 0.008). The majority of the interventions targeted maternal sensitivity. We carried out exploratory analyses to examine factors that may influence treatment outcome but these should be treated with caution given that we were limited by small numbers of studies.ConclusionsParenting interventions that target parental sensitivity show promise in reducing disorganised attachment. This is limited by few high quality studies and the fact that most studies are with mothers. More high quality randomised controlled trials are required to elucidate this further.

Child mental health and resilience in the context of socioeconomic disadvantage: results from the Born in Bradford cohort study

“…The importance of warm and supportive parenting has been established as being crucial in enabling children to develop intrinsic skills and resources important in coping with adversity, including: emotional security; self-belief; self-efficacy; capacity for problem solving; social competence, and a sense of purpose [3,24,34,59]. Underlying many of these qualities is a healthy attachment relationship with a primary caregiver, where research has demonstrated the importance of interventions promoting maternal sensitivity [66]. We suggest that further research is needed to explore the possibility of a 'maternal warmth model' of resilience in children growing up in the context of socioeconomic disadvantage.…”

An initial investigation of neonatal neuroanatomy, caregiving, and levels of disorganized behavior

“…In addition, low levels of parental sensitive caregiving, or the degree to which parents notice and contingently respond to their child's signals (9), have been found to be associated with infant attachment disorganization (10). Likewise, decreased rates of disorganized attachment may be likely after participation in interventions aimed at increasing sensitive parenting (11). Still, the relation between aspects of parenting behavior and attachment disorganization are not always robust, and many have begun to ask whether particular contextual and/or child factors promote associations between exposure to frightening and/or insensitive caregiving and disorganization.…”

‘Caring for children who have experienced trauma’ – an evaluation of a training for foster parents

“…To enhance parental sensitivity and infant attachment security, early preventive interventions can be successful. Meta-analyses of such interventions showed that a moderate number of sessions and a clear-cut behavioural focus were moderately effective elements of attachment-based interventions targeting parental sensitivity and attachment security (Bakermans-Kranenburg, Van IJzendoorn, & Juffer, 2003 ; Facompré, Bernard, & Waters, 2018 ; Wright et al, 2017 ). Interventions with a focus on increasing parental attunement to young children in foster care, such as the Attachment Biobehavioral Catch-Up (ABC) intervention (Lind, Bernard, Ross, & Dozier, 2014 ; Sprang, 2009 ) and the parental sensitivity intervention (Juffer, Bakermans-Kranenburg, & Van IJzendoorn, 2005 ; Stams, Juffer, Van IJzendoorn, & Hoksbergen, 2001 ), share some key components.…”