Family drawings as attachment representations in a sample of post-institutionalized adopted children

Allied health professional support for children and young adults living in and leaving care: A systematic scoping review

BACKGROUND

Children and young people living in and leaving care are known to have experienced significant childhood adversity and trauma resulting in potentially deleterious impact on their health and well-being across the life course. Studies point to the complex needs of this population who may benefit from allied health professional (AHP)-related support with limited studies located. This review sought to address this gap by systematically scoping empirical literature focused on the provision of AHP support to this cohort of children and young adults to assist an understanding of the service needs for this vulnerable population.

METHODS

This scoping review followed Arskey and O'Malley's five steps framework (2005) to identify and review relevant literature. A focus on identifying the evidence, challenges and gaps in research relating to AHP support for children and young people living in and leaving care was initially agreed, followed by a systematic search using a combination of three key concepts to identify relevant studies in five AHP disciplinary areas to identify best evidence in the past decade (2011-2021). Study inclusion criteria were based on empirical studies of children and young people living in care (0-17 years) and leaving care (18-25 years). A data extraction table was formulated as a means of charting the data, aligned with the scope and objectives of this review. Finally, data were subsequently collated, synthesised and reported based on key thematic areas emerging from included studies regarding AHP support to children and young people living in and leaving care.

RESULTS

A total of 13 studies met the review inclusion criteria. Included studies reported specifically on speech and language therapist (SLT; n = 5), occupational therapist (OT; n = 3) and arts-based therapies (n = 5). No studies were identified with regard to the use of physiotherapy and dietetics with this population. Results indicated that children and young people living in and leaving care have high rates of speech, language, communication and sensory needs. More rigorous screening, assessment and early intervention were identified as essential for this vulnerable group. Increased multidisciplinary collaboration and OT support for young adults in preparation for transition to independent living was identified as an urgent requirement. Included studies indicate promising results in relation to access to arts-based therapies with particular reference to identity formation for children and young people living in and leaving care.

CONCLUSIONS

Although evidence of effectiveness remains limited, AHP service provision (specifically speech and language therapy, occupational therapy and arts-based therapies) has the potential to contribute positively to addressing the complex and interacting needs of this vulnerable population. As a result, it is recommended that AHP service provision is integrated into the collaborative, multidisciplinary care available to children living in and leaving care. More extensive, higher quality research related to the benefits of AHP provision for this population of children and young people is essential to provide a more robust evidence base across the various professional disciplines that constitute allied health provision.

Can the family drawing be a useful tool for assessing attachment representations in children? A systematic review and meta-analysis

A systematic review and meta-analysis were conducted to evaluate the quality and validity of Family Drawings (FD) with an Attachment-Based Coding System in assessing attachment representations among pre-school and school-age children. A literature search in notable databases identified 645 records, of which 20 were eligible after screening and quality assessment. Results showed: 1) ABCD attachment distribution in community children was: 48% secure, 20% avoidant, 21% ambivalent, 11% disorganized. Security prevailed both in classifications and Fury et al.' scales. 2) No significant differences according to the cultural background; 3) At-risk/clinical children showed higher insecurity than community ones using scales; 4) Girls were more secure than boys. In conclusion, FD may be a culture-fair method to assess attachment representations in children. Global scales seem more reliable than ABCD classifications for discriminating at-risk and clinical children, but further studies on these groups are needed.

Attachment quality assessed from children's family drawings links to child conduct problems and callous-unemotional behaviors

OBJECTIVE

Recently, there has been considerable research on the origins of childhood conduct problems (CP) and callous-unemotional (CU) behaviors. This study examined associations between children's attachment representations and CP and CU behaviors during middle childhood.

METHOD

At 1st grade, 1,292 children (57% European American, 42.5% African American, 0.5% other race; 50.9% girls) completed a drawing of their family, which was coded by trained raters to assess attachment representations. Primary caregivers reported on children's CP and CU behaviors.

RESULTS

Children with disorganized representations showed more CP and CU behaviors than children with secure and resistant representations. They were also more likely than those with secure representations to show elevated CP without CU behaviors, CU behaviors only, and co-occurring CP and CU behaviors.

CONCLUSION

These findings provide support for attachment disorganization as a correlate of CP and CU behaviors and suggest that attachment representations are likely important proximal influences on children's behavior.

The quality of the relationship between typically developing children and their siblings with and without intellectual disability: Insights from children's drawings

The current study examined the relationships of typically developing (TD) children with siblings with and without intellectual disabilities (ID), as expressed in TD children's drawings and questionnaires answered by TD children and their mothers. It also examined group differences in the sibling relationships, as well as the associations between having a sibling with or without ID and sibling relationships, and TD children's social-emotional adjustment. Participants were mothers and their TD children (8-13 years). Some had ID siblings ID (N=28); others had TD siblings (N=31). Sibling relationships were examined via mothers' and target children's completion of questionnaires, and objective visual indicators (location, size, distance) and observed content-based indicators (support, investment, presence of parents) of children's drawings were assessed following the art-based phenomenological analytic approach. Mothers reported on children's social-emotional adjustment. Findings indicated differences in sibling relationships, including higher levels of positive relationships for children with ID siblings. Children's drawings also showed positive relationship aspects for these children. Sibling relationship qualities were significantly associated with children's adjustment. Children's drawings may be a useful data gathering tool to deepen our understanding of unique aspects of sibling relationships.

Attachment across the lifespan: insights from adoptive families

Research with adoptive families offers novel insights into longstanding questions about the significance of attachment across the lifespan. We illustrate this by reviewing adoption research addressing two of attachment theory's central ideas. First, studies of children who were adopted after experiencing severe adversity offer powerful tests of the unique consequences of experiences in early attachment relationships. Although children who experience early maltreatment or institutionalization show remarkable recovery in the quality of their attachments after being placed with their adoptive families, experiencing pre-adoptive adversity also has long-lasting repercussions for these individuals' later attachment representations. Second, adoptive families allow for genetically-informed examinations of the intergenerational transmission process. Indeed, despite the lack of genetic relatedness, adoptive parents' attachment representations are associated with their children's attachment behaviors and representations across childhood and adolescence.