Treating children with disturbed attachment and an intellectual disability: Effectiveness of theraplay-based treatment.

Abstract

There are no robust evidence-based interventions to treat disturbed attachment in school-aged children. Children with both mild to borderline intellectual disability (MBID) and disturbed attachment are an even more challenging population to serve, even though disturbed attachment is even more prevalent in children with MBID. Theraplay is a widely used intervention for this population, which has been demonstrated to improve the parent-child relationship in numerous nonrandomized controlled trial studies. The effect of a Theraplaybased treatment on the parent-child relationship was evaluated in mother-child dyads with children with MBID and disturbed attachment. The dyads who received a Theraplay-based treatment were monitored at three time points: (a) start of waiting list, (b) start of treatment, and (c) end of treatment, which is part of standard clinical practice. Mother-child interaction was recorded by video observation and scored using the Dyadic Emotional Interaction Style assessment. Maternal representation of the child was scored using a Parental Stress Questionnaire. More than half of the 28 participants dropped out of treatment before the last measurement took place. The data of the other 12 mother-child dyads were retrospectively analyzed, and the treatment effect was compared to baseline variance, using a repeated measures analysis of variance for interaction and a paired samples t test for representation. Significant improvement in interaction quality and representational quality was found between both baseline measurements and posttreatment. A Theraplay-based treatment improves the mother-child relationship in children with a MBID, and as such shows promising effectiveness in treating disturbed attachment in this population.