Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review

Abstract

Background: Adopted children and children placed in foster care are at increased risk of developing a range of mental health, behavioural, and psychosocial adjustment problems. Previous studies suggest that due to early experiences of separation and loss some children may have difficulties forming a secure attachment relationship with the adoptive/foster parents.Objectives: The objectives of the present review were: (1) to assess the efficacy of attachment-based interventions on measures of favourable parent/child outcomes (attachment security, dyadic interaction, parent/child psychosocial adjustment, behavioural and mental health problems, and placement breakdown) within foster and adoptive families with children aged between 0 and 17 years. (2) to identify factors that appear to be associated with more effective outcomes and factors that modify intervention effectiveness (e.g., age of the child at placement and at intervention start, programme duration, programme focus).Search Methods: Relevant studies were identified through electronic searches of bibliographic databases, governmental and grey literature repositories, hand search in specific targeted journals, citation tracking, contact to international experts and Internet search engines. The database searches were carried out to October 2020. SelectionCriteria: The interventions of interest were parenting interventions aimed at helping the foster/adopted children and their parents to form or sustain a secure attachment relationship. The interventions had to be at least partly informed by attachment theory. Data Collection and Analysis: The total number of potentially relevant studies constituted 17.822 hits after duplicates were removed. A total of 44 studies (27 different populations) met the inclusion criteria and were critically appraised by the review authors. Due to critical study quality, missing numeric data and re-use of the same data, only 24 studies analysing 16 different populations could be used in the data synthesis (children, N = 1302; parents, N = 1344). Meta-analysis using both child and parent outcomes were conducted on each metric separately. All analyses

Holding a foster child’s mind in mind: study protocol for a cluster-randomized controlled trial of mentalization-based therapy (MBT) for foster families

“…Theoretically, the difficulties experienced by foster families and the behavioral and emotional symptoms exhibited by the children may be understood through an attachment lens [ 18 ]. According to attachment theory, early caregiving experiences influence adaptation and maladaptation across the lifespan by organizing the child’s individual and relational developmental processes “from the cradle to the grave” [ 19 ].…”

“…Development of more secure attachment and less disorganized child attachment representations are proposed as factors that can reduce behavioral problems and socioemotional maladjustment symptoms in the children. Understanding and promoting the mechanisms by which foster parents can help children placed in their care to develop more secure and less disorganized attachments is, therefore, an urgent priority [ 18 ].…”

“…Finally, a recent systematic Campbell review explored the effects of attachment-based parenting interventions for foster and adoptive families. The review included 44 studies reporting 27 different samples (19 randomized trials and eight non-randomized studies) [ 18 ]. The meta-analyses show improvement in the overall psychosocial adjustment of the child and improvement of positive parent and child behavior and parenting stress post-intervention.…”

“…Within the review, a meta-analysis was conducted using attachment outcomes. However, in line with the findings regarding the prevalence of attachment representations and attachment styles in foster children, the meta-analysis using attachment as an outcome was inconclusive due to the very limited number of studies that reported on attachment as an outcome (k = 3) [ 18 ].…”

“…Most attachment-based parenting interventions are designed for relatively young children [ 17 ]. This is reflected in the fact that the mean age of the children included in a recent review of attachment-based interventions was 5.15 years [ 18 ]. In Denmark, however, children who are placed in foster care are 11.3 years on average at their first placement [ 44 ], and thus there is a strong need for interventions to support foster families with older children.…”