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Talmón-Knuser F, Soler M, González-Sala F, Lacomba-Trejo L, Samper-García P. A Systematic Review on Assessing Assessments: Unveiling Psychometric Properties of Instruments for Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in Minors under Protective Measures. CHILDREN (BASEL, SWITZERLAND) 2024; 11:144. [PMID: 38397256 PMCID: PMC10887385 DOI: 10.3390/children11020144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) manifest in individuals facing attachment system challenges, particularly observed in minors under protective measures. The lack of standardized tools for assessing these difficulties and uncertainty about the most effective instruments from a psychometric perspective prompted this study. AIM Using the COSMIN checklist, we systematically reviewed instruments assessing RAD, adhering to PRISMA. METHODOLOGY Examined tools included the Disturbance Attachment Interview, Preschool Age Psychiatric Assessment, Relationship Patterns Questionnaire, Assessment of RAD and DSED, Development and Well-Being Assessment, and Reactive Attachment Disorder Questionnaire. RESULTS Of the 10 articles analyzed, the results highlight a research emphasis on internal consistency and structural and construct validity, sidelining other properties. CONCLUSION Most articles review structural validity and internal consistency. These measures are satisfactory but insufficiently evaluated. It is necessary to evaluate these tools using other indicators such as cross-cultural validity, measurement error, or responsiveness in adolescents under protective measures.
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Affiliation(s)
- Florencia Talmón-Knuser
- Department of Developmental Psychology and Education, Faculty of Health Science, Catholic University of Uruguay, Montevideo 11600, Uruguay
| | - Miriam Soler
- Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
| | - Francisco González-Sala
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
| | - Laura Lacomba-Trejo
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
| | - Paula Samper-García
- Department of Basic Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
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Shorey S, Asurlekar AR, Chua JS, Lim LHK. Influence of oxytocin on parenting behaviors and parent-child bonding: A systematic review. Dev Psychobiol 2023; 65:e22359. [PMID: 36811366 DOI: 10.1002/dev.22359] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 12/31/2022]
Abstract
Oxytocin (OT) plays a pivotal role in early parent-child relationship formation and bonding that is critical for the social, cognitive, and emotional development of the child. Therefore, this systematic review aims to consolidate all available evidence regarding the associations of parental OT concentration levels with parenting behavior and bonding within the past 20 years. A systematic search was conducted in five databases from 2002 to May 2022, and 33 studies were finalized and included. Due to the heterogeneity of the data, findings were presented narratively based on the type of OT and parenting outcomes. Current evidence strongly suggests that parental OT levels are positively related to parental touch and parental gaze and affect synchrony and observer-coded parent-infant bonding. No gender difference in OT levels was observed between fathers and mothers, but OT strengthens affectionate parenting in mothers and stimulatory parenting in fathers. Child OT levels were also positively associated with parental OT levels. Family and healthcare providers could encourage more positive touch and interactive play between parent and child to strengthen parent-child relationships.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alpana Rajesh Asurlekar
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jing Shi Chua
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lina Hsiu Kim Lim
- Immunology Translational Research Program and Department of Physiology, National University of Singapore, Singapore
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Wright B, Fearon P, Garside M, Tsappis E, Amoah E, Glaser D, Allgar V, Minnis H, Woolgar M, Churchill R, McMillan D, Fonagy P, O’Sullivan A, McHale M. Routinely used interventions to improve attachment in infants and young children: a national survey and two systematic reviews. Health Technol Assess 2023; 27:1-226. [PMID: 36722615 PMCID: PMC9900465 DOI: 10.3310/ivcn8847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice have a limited evidence base, meaning that we cannot be sure if they are helpful or harmful. OBJECTIVES This research aimed to conduct a large-scale survey to identify what interventions are being used in UK services to improve child attachment; conduct a systematic review to evaluate the evidence for parenting attachment interventions; and develop recommendations for future research and practice. DESIGN AND METHODS We worked closely with our Expert Reference Group to plan a large-scale survey focused on relevant UK services. We then conducted two systematic reviews. One searched for all randomised controlled trial evidence for any attachment parenting intervention. The second searched for all research for the top 10 routinely used interventions identified from the survey. RESULTS The survey collected 625 responses covering 734 UK services. The results identified the 10 most commonly used interventions. The responses showed a limited use of validated measures and a wide variety of definitions of attachment. For the first review, seven studies were included from 2516 identified records. These were combined with results from previous reviews conducted by the team. Meta-analyses showed that, overall, parenting interventions are effective in reducing disorganised attachment (pooled odds ratio 0.54, 95% confidence interval 0.39 to 0.77) and increasing secure attachment (pooled odds ratio 1.85, 95% confidence interval 1.36 to 2.52). The second review searched the literature for the top 10 routinely used interventions identified by the survey; 61 studies were included from 1198 identified records. The results showed that many of the most commonly used interventions in UK services have a weak evidence base and those with the strongest evidence base are not as widely used. CONCLUSIONS There is a need for better links between research and practice to ensure that interventions offered to families are safe and effective. Possible reasons for the disparity include the cost and accessibility of training. There is also a need for improved understanding by professionals regarding the meaning of attachment. LIMITATIONS Although the survey had good geographical spread, most respondents were based in England. For review 2 we were unable to access a large number of papers; however, we conducted extensive reference checking to account for this. FUTURE WORK There is a need for robust research to test the efficacy of routinely used attachment interventions. Research could also explore why routinely used interventions are not consistently subject to thorough evaluation; how to embed dissemination, cost-effectiveness, fidelity and sustainability into research; and how to keep clinical practice up to date with research developments. STUDY REGISTRATION This study is registered as PROSPERO CRD42019137362. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barry Wright
- Hull York Medical School, University of York, York, UK
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Megan Garside
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Eleni Tsappis
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Elaine Amoah
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Danya Glaser
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Victoria Allgar
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Kohlhoff J, Lieneman C, Cibralic S, Traynor N, McNeil CB. Attachment-Based Parenting Interventions and Evidence of Changes in Toddler Attachment Patterns: An Overview. Clin Child Fam Psychol Rev 2022; 25:737-753. [PMID: 35982272 PMCID: PMC9622506 DOI: 10.1007/s10567-022-00405-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/09/2022]
Abstract
There is strong evidence to show links between attachment security in young children and a range of positive outcomes in social, emotional, and psychological domains. The aims of this review were to provide a narrative summary of (1) the attachment-based interventions currently available for caregivers of toddlers aged 12-24 months and for which research about the impact of the program on child attachment patterns has been reported, and (2) the empirical effectiveness of these interventions at improving attachment security. A number of interventions were shown to be associated with shifts to secure and/or organized attachment, with Child-Parent Psychotherapy and Attachment and Biobehavioral Catch-Up emerging as the interventions with the strongest evidence bases. For most interventions, evidence came from just a single research study, and in some cases from studies that were not randomized controlled trials. In order for clinicians to make informed decisions about the interventions they use with parents and toddlers, it is vital that further research be conducted to test the efficacy of all available attachment-based parenting programs using randomized controlled trial designs, in a range of settings and clinical and cultural groups, and with longitudinal follow-ups.
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Affiliation(s)
- Jane Kohlhoff
- School of Psychiatry, University of New South Wales, PO Box 241, Villawood, NSW, 2163, Australia.
- Karitane, Villawood, Australia.
| | - Corey Lieneman
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Australia
| | - Sara Cibralic
- School of Psychiatry, University of New South Wales, PO Box 241, Villawood, NSW, 2163, Australia
| | - Nicole Traynor
- School of Psychiatry, University of New South Wales, PO Box 241, Villawood, NSW, 2163, Australia
| | - Cheryl B McNeil
- Department of Psychology, West Virginia University, Morgantown, USA
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Chua JYX, Shorey S. Effectiveness of mobile application-based perinatal interventions in improving parenting outcomes: A systematic review. Midwifery 2022; 114:103457. [PMID: 35985142 PMCID: PMC9364944 DOI: 10.1016/j.midw.2022.103457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/25/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022]
Abstract
Objective Parents face many challenges during the perinatal period and are at risk for mental health issues, especially during the current coronavirus (COVID-19) pandemic. Mobile application-based interventions can help parents to improve their psychosocial well-being in a convenient and accessible manner. This review aims to examine the effectiveness of mobile application-based perinatal interventions in improving parenting self-efficacy, anxiety, and depression (primary outcomes), as well as stress, social support, and parent-child bonding (secondary outcomes) among parents. Methods Seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, and ProQuest Thesis and Dissertations) were searched from their respective inception dates until August 2021. The Cochrane Risk of Bias-2 tool was used to conduct quality appraisals. Results were narratively synthesized due to the high heterogeneity of intervention and participant types. Findings A total of 6164 articles were retrieved from the seven electronic databases and citation searching. After excluding duplicate records and irrelevant titles/abstracts, 105 full texts were examined. Full-text screening excluded another 93 articles, leaving 12 included studies in this review. All studies were rated as having some concerns or a high overall risk of bias. Mobile application-based interventions were found to be feasible and promising in improving parents’ overall well-being post-intervention during the perinatal period. Further research would be needed to determine their long-term effects. Key conclusions and implications for practice Parental well-being was shown to improve using the following intervention components: educational resources on perinatal and infant care, psychotherapy, and support from peers and healthcare professionals. Hence, future interventions could aim to include these components and evaluate all inter-related parenting outcomes (parenting self-efficacy, stress, anxiety, depression, social support, and parent-child bonding). Parents could be provided with experiential learning exposure by using computer animations and virtual reality. Future research could be conducted on more fathers and parents from varied geographical regions.
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Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive 117597, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive 117597, Singapore.
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Oliveira P, Stevens E, Barge L, Comyn J, Langley K, Ramchandani P, Wright B, Woolgar M, Kennedy E, Byford S, Shearer J, Scott S, Barlow J, Glaser D, Senior R, Fonagy P, Fearon P. A modified video-feedback intervention for carers of foster children aged 6 years and under with reactive attachment disorder: a feasibility study and pilot RCT. Health Technol Assess 2022; 26:1-106. [PMID: 35959710 DOI: 10.3310/sliz1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder. However, access to interventions varies widely and there are no evidence-based interventions for this disorder. OBJECTIVES (1) To adapt an existing video-feedback intervention to meet the specific needs of foster children in the UK with reactive attachment symptoms, (2) to conduct a case series to road-test the treatment manual and study procedures, (3) to conduct a scoping study of the key hurdles in a pilot trial and (4) to conduct a pilot randomised controlled trial of the adapted intervention to determine the feasibility of a future full-scale trial. DESIGN This was a mixed-methods study. The adapted treatment manual was developed with expert input and tested on a small case series. Qualitative interviews with key stakeholders were used in the scoping study in preparation for the trial and later with foster carers who received the new intervention. The final stage was a feasibility and pilot randomised controlled trial of the new intervention, compared with usual care. Researchers assessing the outcomes were blinded to group assignment. SETTING The study was set in outpatient child and adolescent mental health services and partner social services departments. Sites included urban and rural/semirural areas. PARTICIPANTS Participants were foster carers with children aged ≤ 6 years presenting with difficulties in the domain of reactive attachment disorder. Key stakeholders included children's services managers and mental health service practitioners in the scoping study. Foster carers who received the modified intervention participated in qualitative interviews. INTERVENTION The video-feedback intervention to promote positive parenting and sensitive discipline is an extensively evaluated and effective treatment approach. This intervention was modified (based on the adapted version for foster care in the Netherlands) to suit the needs of young children with reactive attachment symptoms in foster care in the UK and was delivered to improve the sensitive responding of foster carers, foster carer-child relationships and child outcomes. The modified intervention was delivered in-home by trained mental health professionals over a period of 4-6 months. MAIN OUTCOME MEASURE The main outcome was reactive attachment symptom scores on the Disturbances of Attachment Interview. RESULTS A series of minor changes to the intervention programme were introduced, which focused on improving its suitability for the UK foster care context. Challenges in recruitment meant that, despite numerous modifications to the protocol and the inclusion of additional sites, only 30 families (target, n = 40) were recruited to the randomised controlled trial (15 allocated to each group). However, most other trial parameters were deemed feasible and acceptable, particularly the high levels of data and treatment completeness. All randomised families were available for baseline analyses, but two in the treatment arm were not available for post-treatment analyses. The revised intervention was positively received by practitioners and foster carers. LIMITATIONS Only three-quarters of the target sample size was recruited. Furthermore, the sites' own exclusion of potential participants and the low return rates of screening questionnaires raise the possibility of non-randomness of non-responses. CONCLUSION A larger-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended. Central resourcing of intervention capacity to supplement NHS staff is also recommended. TRIAL REGISTRATION This trial is registered as ISRCTN18374094. FUNDING This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paula Oliveira
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud National Centre for Children and Families, London, UK
| | - Eloise Stevens
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud National Centre for Children and Families, London, UK
| | - Lydia Barge
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud National Centre for Children and Families, London, UK
| | - Julie Comyn
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Kirsty Langley
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Barry Wright
- Department of Health Sciences, University of York, York, UK
| | - Matt Woolgar
- National Adoption & Fostering Service, South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eilis Kennedy
- Research and Development Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - James Shearer
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephen Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Danya Glaser
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rob Senior
- Research and Development Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud National Centre for Children and Families, London, UK
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud National Centre for Children and Families, London, UK
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Oliveira P, Barge L, Stevens E, Byford S, Shearer J, Spies R, Comyn J, Langley K, Ramchandani P, Wright B, Woolgar M, Kennedy E, Scott S, Barlow J, Glaser D, Senior R, Fonagy P, Fearon P. Children in foster care with symptoms of reactive attachment disorder: feasibility randomised controlled trial of a modified video-feedback parenting intervention. BJPsych Open 2022; 8:e134. [PMID: 35848060 PMCID: PMC9347233 DOI: 10.1192/bjo.2022.538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD. AIMS To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility of conducting a randomised controlled trial (RCT) of the modified intervention. METHOD The intervention was modified with expert input and tested on a case series. A feasibility and pilot RCT compared the new intervention with usual care. Foster carers and children in their care aged ≤6 years were recruited across nine local authorities, with 1:1 allocation and blind post-treatment assessments. The modified intervention was delivered in-home by trained mental health professionals over 4-6 months. Children were assessed for RAD symptoms, attachment quality and emotional/behavioural difficulties, and foster carers were assessed for sensitivity and stress. RESULTS Minimal changes to the intervention programme were necessary, and focused on improving its suitability for the UK foster care context. Recruitment was challenging, and remained below target despite modifications to the protocol and the inclusion of additional sites. Thirty families were recruited to the RCT; 15 were allocated to each group. Most other feasibility outcomes were favourable, particularly high numbers of data and treatment completeness. The revised intervention was positively received by practitioners and foster carers. CONCLUSIONS A large-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended.
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Affiliation(s)
- Paula Oliveira
- Division of Psychology and Language Sciences, University College London, UK; and Anna Freud National Centre for Children and Families, UK
| | - Lydia Barge
- Division of Psychology and Language Sciences, University College London, UK; and Anna Freud National Centre for Children and Families, UK
| | - Eloise Stevens
- Division of Psychology and Language Sciences, University College London, UK; and Anna Freud National Centre for Children and Families, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - James Shearer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ruan Spies
- School of Psychosocial Health, North-West University, South Africa
| | - Julie Comyn
- Division of Psychology and Language Sciences, University College London, UK
| | - Kirsty Langley
- Division of Psychology and Language Sciences, University College London, UK
| | | | - Barry Wright
- Hull York Medical School, University of York, UK
| | - Matt Woolgar
- South London and Maudsley NHS Trust, UK; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Eilis Kennedy
- Research and Development Unit, Tavistock and Portman NHS Foundation Trust, UK
| | - Stephen Scott
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, UK
| | - Danya Glaser
- Great Ormond Street Hospital for Children, UK; and Division of Psychology and Language Sciences, University College London, UK
| | - Rob Senior
- Research and Development Unit, Tavistock and Portman NHS Foundation Trust, UK
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, UK; and Anna Freud National Centre for Children and Families, UK
| | - Pasco Fearon
- Division of Psychology and Language Sciences, University College London, UK; Anna Freud National Centre for Children and Families, UK; and Centre for Family Research, University of Cambridge, UK
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Bywater T, Dunn A, Endacott C, Smith K, Tiffin PA, Price M, Blower S. The Measurement Properties and Acceptability of a New Parent-Infant Bonding Tool ('Me and My Baby') for Use in United Kingdom Universal Healthcare Settings: A Psychometric, Cross-Sectional Study. Front Psychol 2022; 13:804885. [PMID: 35237212 PMCID: PMC8883030 DOI: 10.3389/fpsyg.2022.804885] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The National Institute for Health and Care Excellence (NICE) guidelines acknowledge the importance of the parent-infant relationship for child development but highlight the need for further research to establish reliable tools for assessment, particularly for parents of children under 1 year. This study explores the acceptability and psychometric properties of a co-developed tool, 'Me and My Baby' (MaMB). STUDY DESIGN A cross-sectional design was applied. The MaMB was administered universally (in two sites) with mothers during routine 6-8-week Health Visitor contacts. The sample comprised 467 mothers (434 MaMB completers and 33 'non-completers'). Dimensionality of instrument responses were evaluated via exploratory and confirmatory ordinal factor analyses. Item response modeling was conducted via a Rasch calibration to evaluate how the tool conformed to principles of 'fundamental measurement'. Tool acceptability was evaluated via completion rates and comparing 'completers' and 'non-completers' demographic differences on age, parity, ethnicity, and English as an additional language. Free-text comments were summarized. Data sharing agreements and data management were compliant with the General Data Protection Regulation, and University of York data management policies. RESULTS High completion rates suggested the MaMB was acceptable. Psychometric analyses showed the response data to be an excellent fit to a unidimensional confirmatory factor analytic model. All items loaded statistically significantly and substantially (>0.4) on a single underlying factor (latent variable). The item response modeling showed that most MaMB items fitted the Rasch model. (Rasch) item reliability was high (0.94) yet the test yielded little information on each respondent, as highlighted by the relatively low 'person separation index' of 0.1. CONCLUSION AND NEXT STEPS MaMB reliably measures a single construct, likely to be infant bonding. However, further validation work is needed, preferably with 'enriched population samples' to include higher-need/risk families. The MaMB tool may benefit from reduced response categories (from four to three) and some modest item wording amendments. Following further validation and reliability appraisal the MaMB may ultimately be used with fathers/other primary caregivers and be potentially useful in research, universal health settings as part of a referral pathway, and clinical practice, to identify dyads in need of additional support/interventions.
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Affiliation(s)
- Tracey Bywater
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Abigail Dunn
- Department of Social Policy and Social Work, University of York, York, United Kingdom
| | - Charlotte Endacott
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Karen Smith
- Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, United Kingdom
| | - Paul A. Tiffin
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Matthew Price
- Little Minds Matter Bradford Infant Mental Health Service, Bradford District Care NHS Foundation Trust, Bradford, United Kingdom
| | - Sarah Blower
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
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9
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Rooksby M, Di Folco S, Tayarani M, Vo DB, Huan R, Vinciarelli A, Brewster SA, Minnis H. The School Attachment Monitor-A novel computational tool for assessment of attachment in middle childhood. PLoS One 2021; 16:e0240277. [PMID: 34292952 PMCID: PMC8297900 DOI: 10.1371/journal.pone.0240277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
Background Attachment research has been limited by the lack of quick and easy measures. We report development and validation of the School Attachment Monitor (SAM), a novel measure for largescale assessment of attachment in children aged 5–9, in the general population. SAM offers automatic presentation, on computer, of story-stems based on the Manchester Child Attachment Story Task (MCAST), without the need for trained administrators. SAM is delivered by novel software which interacts with child participants, starting with warm-up activities to familiarise them with the task. Children’s story completion is video recorded and augmented by ‘smart dolls’ that the child can hold and manipulate, with movement sensors for data collection. The design of SAM was informed by children of users’ age range to establish their task understanding and incorporate their innovative ideas for improving SAM software. Methods 130 5–9 year old children were recruited from mainstream primary schools. In Phase 1, sixty-one children completed both SAM and MCAST. Inter-rater reliability and rating concordance was compared between SAM and MCAST. In Phase 2, a further 44 children completed SAM complete and, including those children completing SAM in Phase 1 (total n = 105), a machine learning algorithm was developed using a “majority vote” procedure where, for each child, 500 non-overlapping video frames contribute to the decision. Results Using manual rating, SAM-MCAST concordance was excellent (89% secure versus insecure; 97% organised versus disorganised; 86% four-way). Comparison of human ratings of SAM versus the machine learning algorithm showed over 80% concordance. Conclusions We have developed a new tool for measuring attachment at the population level, which has good reliability compared to a validated attachment measure and has the potential for automatic rating–opening the door to measurement of attachment in large populations.
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Affiliation(s)
- Maki Rooksby
- University of Glasgow, Institute of Health and Wellbeing, Glasgow, United Kingdom
| | - Simona Di Folco
- University of Edinburgh, School of Health in Social Science, Edinburgh, United Kingdom
| | - Mohammad Tayarani
- School of Computing Science, University of Glasgow, Glasgow, United Kingdom
| | - Dong-Bach Vo
- School of Computing Science, University of Glasgow, Glasgow, United Kingdom
| | - Rui Huan
- School of Computing Science, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Helen Minnis
- University of Glasgow, Institute of Health and Wellbeing, Glasgow, United Kingdom
- * E-mail:
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Diebold A, Johnson JK, Brennan M, Ciolino JD, Petitclerc A, Wakschlag LS, Garfield CF, Yeh C, Lovejoy A, Zakieh D, Tandon SD. Testing the effects of a prenatal depression preventive intervention on parenting and young children's self-regulation and functioning (EPIC): protocol for a longitudinal observational study. BMC Public Health 2021; 21:1368. [PMID: 34246233 PMCID: PMC8271322 DOI: 10.1186/s12889-021-11385-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Perinatal depression is a pervasive public health concern that disproportionately affects low-income women and can have negative impacts on parenting and child developmental outcomes. Few interventions focus on preventing perinatal depression. Previous studies suggest that Mothers and Babies is efficacious in preventing the worsening of depressive symptoms and the onset of postpartum depression. This manuscript presents the protocol of the EPIC study (Effects of a Prenatal Depression Preventive Intervention on parenting and young children's Self-Regulation and Functioning) to test the effects of Mothers and Babies on parenting and child developmental outcomes through 54 months postpartum. EPIC is an observational study that builds on a completed cluster-randomized trial (CRT). Innovations of this study are direct observations of a subsample of mother-child dyads and the inclusion of fathers/caregivers' variables as moderators of maternal mental health. METHODS For this study, we plan to enroll 738 women with children under 30 months old, ≥18 years old, and who speak English or Spanish. Additionally, 429 fathers, partners, or other adult caregivers will be recruited through women participating in the study. Women will be recruited through the parent study (intervention and control participants) or through one of 10 home visiting programs in Illinois (control participants). Data collection will take place through maternal self-report at five time points (when the child is 30, 36, 42, 48, and 54 months), paternal self-report at three time points (when the child is 30, 42, and 54 months), and through mother-child observations at three time points (when the child is 36, 42, and 48 months). Outcome domains include maternal mental health, cognitive-behavioral and parenting skills, and child self-regulation and functioning. Moderators include the contributions of fathers/caregivers, race-ethnicity, and socioeconomic disadvantage. Power and sample size were calculated assuming a two-sided 5% type I error rate and assumed analyses on the individual level. DISCUSSION This study has several key strengths and innovations, as well as great potential significance to influence the long-term trajectories of parenting and child development via prenatal intervention. TRIAL REGISTRATION The study was retrospectively registered at ClinicalTrials.gov (Identifier: NCT04296734 ) on March 5, 2020.
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Affiliation(s)
- Alicia Diebold
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA.
| | - Jessica K Johnson
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Marianne Brennan
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Jody D Ciolino
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | | | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2100, Chicago, IL, 60611, USA
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 St. Clair Street, Chicago, IL, 60611, USA
| | - Craig F Garfield
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2100, Chicago, IL, 60611, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, 633 St. Clair Street, Suite 19-059, Chicago, IL, 60611, USA
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 St. Clair Street, Chicago, IL, 60611, USA
| | - Chen Yeh
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Aiko Lovejoy
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Dana Zakieh
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - S Darius Tandon
- Institute for Public Health and Medicine, Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2100, Chicago, IL, 60611, USA
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 St. Clair Street, Chicago, IL, 60611, USA
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O’Neill MC, Badovinac S, Pillai Riddell R, Bureau JF, Rumeo C, Costa S. The longitudinal and concurrent relationship between caregiver sensitivity and preschool attachment: A systematic review and meta-analysis. PLoS One 2021; 16:e0245061. [PMID: 33481826 PMCID: PMC7822304 DOI: 10.1371/journal.pone.0245061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/22/2020] [Indexed: 11/21/2022] Open
Abstract
The present study aimed to systematically review and meta-analyze the concurrent and longitudinal relationship between caregiver sensitivity and preschool attachment measured using the Main and Cassidy (1988) and Cassidy and Marvin (1992) attachment classification systems. This review was pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO; Registration Number CRD42017073417) and completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The present review identified 36 studies made up of 21 samples (N = 3, 847) examining the relationship between caregiver sensitivity and preschool attachment. Eight primary meta-analyses were conducted separately according to the proximity of the assessment of sensitivity to attachment (i.e., concurrent versus longitudinal), operationalization of caregiver sensitivity (i.e., unidimensional versus multidimensional) and attachment categorizations (i.e., secure-insecure versus organized-disorganized). Overall, the meta-analyses revealed higher levels of caregiver sensitivity among caregivers with secure and organized preschoolers, relative to insecure and disorganized preschoolers, respectively. Medium effect sizes (g = .46 to .59) were found for both longitudinal and concurrent associations between caregiver sensitivity and preschool attachment when a unidimensional measure of caregiver sensitivity was employed, compared to small to medium effect sizes (g = .34 to .49) when a multidimensional measure of caregiver sensitivity was employed. Child age at attachment measurement was a significant moderator of the longitudinal association between unidimensional caregiver sensitivity and preschool attachment. Future directions for the literature and clinical implications are discussed.
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Affiliation(s)
| | | | - Rebecca Pillai Riddell
- Department of Psychology, York University, Toronto, Ontario, Canada
- Department of Psychiatry Research, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry and Pharmacy, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | | | - Carla Rumeo
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Stefano Costa
- Department of Psychology, York University, Toronto, Ontario, Canada
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A review and analysis of the components of potentially effective perinatal mental health interventions for infant development and mother-infant relationship outcomes. Dev Psychopathol 2020; 34:37-54. [PMID: 33283694 DOI: 10.1017/s0954579420001340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Children of mothers with serious mental health difficulties are at increased risk of developing mental health difficulties themselves in their own lifetime. Specialist interventions delivered in perinatal mental health services offer an opportunity to support the infant's development and long-term mental health. This review aimed to systematically evaluate the shared elements of successful perinatal mental health interventions that underpin improved outcomes for infants whose mothers experience perinatal mental health difficulties. Nine electronic databases were searched comprehensively for relevant controlled studies of perinatal mental health interventions, and a narrative synthesis undertaken to assess whether statistically significant benefits were noted. Sixteen studies, trialing 19 interventions, were analyzed using a narrative approach and grouped according to reported effectiveness. Eight interventions demonstrated significant improvements in infant outcomes and/or mother-infant relationship outcomes and were used to inform the analysis of the included interventions' components. While the interventions identified were diverse, there were common components which potentially underpin successful interventions for infants whose mothers are experiencing mental health difficulties, including: facilitation of positive Mother×Infant interactions; helping mothers to understand their infant's perspective or inner world; and the use of video feedback.
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Størksen HT, Haga SM, Slinning K, Drozd F. Health Personnel's Perceived Usefulness of Internet-Based Interventions for Parents of Children Younger Than 5 Years: Cross-Sectional Web-Based Survey Study. JMIR Ment Health 2020; 7:e15149. [PMID: 33206058 PMCID: PMC7710450 DOI: 10.2196/15149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 06/09/2020] [Accepted: 10/28/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Approximately 10%-15% of children struggle with different socioemotional and psychological difficulties in infancy and early childhood. Thus, health service providers should have access to mental health interventions that can reach more parents than traditional face-to-face interventions. However, despite increasing evidence on the efficacy of internet-based mental health interventions, the pace in transferring such interventions to health care has been slow. One of the major suggested barriers to this may be the health personnel's attitudes to perceived usefulness of internet-based interventions. OBJECTIVE The purpose of this study was to examine health professionals' perceived usefulness of internet-based mental health interventions and to identify the key areas that they consider new internet-based services to be useful. METHODS Between May and September 2018, 2884 leaders and practitioners of infant and child health services were recruited to a cross-sectional web-based survey through the following channels: (1) existing email addresses from the Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, course database, (2) an official mailing list to infant and child health services, (3) social media, or (4) other recruitment channels. Respondents filled in background information and were asked to rate the usefulness of internet-based interventions for 12 different infant and child mental health problem areas based on the broad categories from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Perceived usefulness was assessed with 1 global item: "How often do you think internet-based self-help programs can be useful for following infant and child mental health problems in your line of work?" The answers were scored on a 4-point scale ranging from 0 (never) to 3 (often). RESULTS The participants reported that they sometimes or often perceived internet-based interventions as useful for different infant and child mental health problems (scale of 0-3, all means>1.61). Usefulness of internet-based interventions was rated acceptable for sleep problems (mean 2.22), anxiety (mean 2.09), and social withdrawal and shyness (mean 2.07), whereas internet-based interventions were rated as less useful for psychiatric problems such as obsessive behaviors (mean 1.89), developmental disorders (mean 1.91), or trauma (mean 1.61). Further, there were a few but small differences in perceived usefulness between service leaders and practitioners (all effect sizes<0.32, all P<.02) and small-to-moderate differences among daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics (all effect sizes<0.69, all P<.006). CONCLUSIONS Internet-based interventions for different infant and child mental health problems within services such as daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics are sometimes or often perceived as useful. These encouraging findings can support the continued exploration of internet-based mental health interventions as a way to improve parental support.
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Affiliation(s)
- Hege Therese Størksen
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Silje Marie Haga
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Kari Slinning
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Filip Drozd
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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Wittkowski A, Vatter S, Muhinyi A, Garrett C, Henderson M. Measuring bonding or attachment in the parent-infant-relationship: A systematic review of parent-report assessment measures, their psychometric properties and clinical utility. Clin Psychol Rev 2020; 82:101906. [PMID: 32977111 PMCID: PMC7695805 DOI: 10.1016/j.cpr.2020.101906] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 08/02/2020] [Accepted: 08/21/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Meaningful, valid and reliable self-report measures can facilitate the identification of important parent-infant-relationship factors, relevant intervention development and subsequent evaluation in community and clinical contexts. We aimed at identifying all available parent-report measures of the parent-infant-relationship or bond and to appraise their psychometric and clinimetric properties. METHOD A systematic review (PROSPERO: CRD42017078512) was conducted using the, 2018 COSMIN criteria. Eight electronic databases were searched. Papers describing the development of self-report measures of the parent-infant-bond, attachment or relationship from pregnancy until two years postpartum or the assessment of their psychometric properties were included. RESULTS Sixty-five articles evaluating 17 original measures and 13 modified versions were identified and reviewed. The studies' methodological quality (risk of bias) varied between 'very good' and 'inadequate' depending on the measurement property assessed; however, scale development studies were mostly of 'inadequate' quality. Although most measures had good clinical utility, the psychometric evaluation of their properties was largely poor. The original or modified versions of the Postpartum Bonding Questionnaire collectively received the strongest psychometric evaluation ratings with high quality of evidence. CONCLUSIONS This novel review revealed that only a few antenatal and postnatal measures demonstrated adequate psychometric properties. Further studies are needed to determine the most robust perinatal measures for researchers and clinicians.
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Affiliation(s)
- A Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Department of Clinical Psychology, Laureate House, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.
| | - S Vatter
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - A Muhinyi
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - C Garrett
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - M Henderson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, 200 Renfield Street, Glasgow G2 3AX, UK
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Kang NR, Kim DH, Kwack YS. The Effect of Community-Based Parent Education Program on Parenting Stress According to Adult Attachment Styles. Soa Chongsonyon Chongsin Uihak 2019; 30:178-184. [PMID: 32595339 PMCID: PMC7298908 DOI: 10.5765/jkacap.190026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/29/2019] [Accepted: 09/16/2019] [Indexed: 11/05/2022] Open
Abstract
Objectives The aim of this study was to measure the effect of a group-based parent education program on parenting stress and attitude and comparing the same according to adult attachment styles. Methods Twenty-two mothers who enrolled in the parent education program participated in our study. The participants filled in the Korean version of the Experience in Close Relationship Revised (ECR-R), Korean-Parenting Stress Index-Short Form (K-PSI-SF), Maternal Behavior Research Instrument (MBRI), and Symptom Checklist-90-Revised (SCL-90-R) before and after the program. We compared the pre-and post-scores of the groups and compared the differences in effect according to adult attachment styles. Results For all study participants, the Parent Distress (p=0.023) and Total Parenting Stress (p=0.018) significantly declined after the parent education program. There were no differences in other variables. Within the secure attachment group, the Total Parenting Stress (p= 0.008), Parent Distress (p=0.015), and Difficult Child (p=0.011) scores in the K-PSI-SF significantly decreased after participating in the program. The Difficult Child scores (p=0.040) significantly dropped in the K-PSI-SF post program within the secure attachment group, compared to the insecure attachment group. Conclusion The group-based parent education program impacted parenting stress. Depending on the adult attachment styles, the effect of the program varied.
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Affiliation(s)
- Na Ri Kang
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Korea
| | - Do Hoon Kim
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
| | - Young Sook Kwack
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Korea
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Schröder M, Fux E, Lüdtke J, Izat Y, Bolten M, Schmid M. German Version of the Relationship Problems Questionnaire: Effective Screening for Attachment Disorder. Psychopathology 2019; 52:334-345. [PMID: 31865355 DOI: 10.1159/000504675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/10/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Attachment disorder (AD), including reactive AD and disinhibited social engagement disorder, is a prevalent, yet underdiagnosed disorder in severely maltreated children. Because the condition is associated with significant psychiatric morbidity over the entire lifespan, a valid and economic screening tool to identify children with clinical symptoms of AD is needed to avoid unspecific or ineffective treatment. The present study aimed to assess the effectiveness and efficiency of the German version of the Relationship Problems Questionnaire (RPQ). METHODS With a total of 135 children (mean age = 7.17 years, SD = 1.40, 63% male) from both general (34 children) and high-risk populations (69 in- and outpatients, 32 foster children), we investigated the sensitivity and specificity of the RPQ. AD was diagnosed using a standardized clinical interview (K-DIPS). 35 out of 135 children fulfilled the criteria for AD. RESULTS The RPQ identified 74% of the children who fulfilled the criteria for AD in the standardized clinical interview. The optimal cut-off score of the RPQ for identifying AD was 4.5 with a moderate sensitivity of 0.74 and specificity of 0.68. CONCLUSIONS The German version of the RPQ proved useful as a diagnostic indicator of clinical symptoms of AD. The tool is economic and suitable for the screening of AD in the general population as well as high-risk populations. We recommend the use of the RPQ in clinical and research settings, adding multi-method approaches after a positive screening.
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Affiliation(s)
- Martin Schröder
- Child and Adolescent Research Department (UPKKJ), Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland, .,Institute of Social Work and Social Pedagogy, Faculty of Education, University of Lüneburg, Lüneburg, Germany,
| | - Elodie Fux
- Child and Adolescent Research Department (UPKKJ), Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland
| | - Janine Lüdtke
- Child and Adolescent Research Department (UPKKJ), Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland
| | - Yonca Izat
- Vivantes Clinic Friedrichshain, Child and Adolescent Psychiatry Berlin, Berlin, Germany
| | - Margarete Bolten
- Child and Adolescent Research Department (UPKKJ), Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Research Department (UPKKJ), Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland
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Grube WA, Liming KW. ATTACHMENT AND BIOBEHAVIORAL CATCH-UP: A SYSTEMATIC REVIEW. Infant Ment Health J 2018; 39:656-673. [PMID: 30365173 DOI: 10.1002/imhj.21745] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Attachment Biobehavioral Catch-up (ABC; Dozier et al., 2006) is a 10-week, in-home intervention primarily for early childhood aged children (ages 6 months-2 years). The ABC intervention seeks to teach parents how to provide nurturing care and engage in appropriate interactions with their children. ABC has been identified as a Level 1 evidence-based practice by the California Evidence-Based Clearinghouse for Child Welfare. However, to date, there has been no systematic review presenting the overall evidence behind ABC available in a peer-reviewed journal. The objective of this review is to address this gap by synthesizing prior literature and evidence, specifically evidence from randomized control trials (RCTs), regarding the effectiveness of the ABC intervention and to determine the contexts in which the intervention has been implemented. To complete this review, literature was searched across three bibliographic databases and relevant Web sites. Only RCTs examining child outcomes were included in the review. Using identified search procedures, 10 articles discussing RCTs which tested the efficacy of ABC were identified. Findings indicate that ABC is effective, when implemented with child-welfare-involved children, at improving emotion regulation, improving externalizing and internalizing behaviors, increasing normative developmental functioning, and attachment quality. Sample information from the 10 RCTs identified is presented as well as additional study characteristics.
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Edginton E, Walwyn R, Burton K, Cicero R, Graham L, Reed S, Tubeuf S, Twiddy M, Wright-Hughes A, Ellis L, Evans D, Hughes T, Midgley N, Wallis P, Cottrell D. TIGA-CUB - manualised psychoanalytic child psychotherapy versus treatment as usual for children aged 5-11 years with treatment-resistant conduct disorders and their primary carers: study protocol for a randomised controlled feasibility trial. Trials 2017; 18:431. [PMID: 28915904 PMCID: PMC5602865 DOI: 10.1186/s13063-017-2166-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/30/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) recommends evidence-based parenting programmes as a first-line intervention for conduct disorders (CD) in children aged 5-11 years. As these are not effective in 25-33% of cases, NICE has requested research into second-line interventions. Child and Adolescent Psychotherapists (CAPTs) address highly complex problems where first-line treatments have failed and there have been small-scale studies of Psychoanalytic Child Psychotherapy (PCP) for CD. A feasibility trial is needed to determine whether a confirmatory trial of manualised PCP (mPCP) versus Treatment as Usual (TaU) for CD is practicable or needs refinement. The aim of this paper is to publish the abridged protocol of this feasibility trial. METHODS AND DESIGN TIGA-CUB (Trial on improving Inter-Generational Attachment for Children Undergoing Behaviour problems) is a two-arm, pragmatic, parallel-group, multicentre, individually randomised (1:1) controlled feasibility trial (target n = 60) with blinded outcome assessment (at 4 and 8 months), which aims to develop an optimum practicable protocol for a confirmatory, pragmatic, randomised controlled trial (RCT) (primary outcome: child's behaviour; secondary outcomes: parental reflective functioning and mental health, child and parent quality of life), comparing mPCP and TaU as second-line treatments for children aged 5-11 years with treatment-resistant CD and inter-generational attachment difficulties, and for their primary carers. Child-primary carer dyads will be recruited following a referral to, or re-referral within, National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) after an unsuccessful first-line parenting intervention. PCP will be delivered by qualified CAPTs working in routine NHS clinical practice, using a trial-specific PCP manual (a brief version of established PCP clinical practice). Outcomes are: (1) feasibility of recruitment methods, (2) uptake and follow-up rates, (3) therapeutic delivery, treatment retention and attendance, intervention adherence rates, (4) follow-up data collection, and (5) statistical, health economics, process evaluation, and qualitative outcomes. DISCUSSION TIGA-CUB will provide important information on the feasibility and potential challenges of undertaking a confirmatory RCT to evaluate the effectiveness and cost-effectiveness of mPCP. TRIAL REGISTRATION Current Controlled Trials, ID: ISRCTN86725795 . Registered on 31 May 2016.
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Affiliation(s)
- Elizabeth Edginton
- Child Oriented Mental health Interventions Centre (COMIC), Leeds and York Partnership NHS Foundation Trust, University of York, IT Building, Innovation Way, York, YO10 5NP UK
| | - Rebecca Walwyn
- Leeds Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Kayleigh Burton
- Leeds Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Robert Cicero
- Leeds Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Liz Graham
- Leeds Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Sadie Reed
- Leeds Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Sandy Tubeuf
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Maureen Twiddy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Lynda Ellis
- Northern School of Child and Adolescent Psychotherapy (NSCAP), Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | | | - Tom Hughes
- General Adult Psychiatry, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK
| | - Paul Wallis
- The Winnicott Centre, CAMHS Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - David Cottrell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Wright B, Hackney L, Hughes E, Barry M, Glaser D, Prior V, Allgar V, Marshall D, Barrow J, Kirby N, Garside M, Kaushal P, Perry A, McMillan D. 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. PLoS One 2017; 12:e0180858. [PMID: 28708838 PMCID: PMC5510823 DOI: 10.1371/journal.pone.0180858] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/22/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Disorganised 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. OBJECTIVES The 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. METHODS Population: 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. RESULTS A 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. CONCLUSIONS Parenting 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.
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Affiliation(s)
- Barry Wright
- Hull York Medical School, University of York, York, United Kingdom
- Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
- * E-mail:
| | - Lisa Hackney
- Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Ellen Hughes
- Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Melissa Barry
- Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Danya Glaser
- Great Ormond Street Hospital and University College, London, United Kingdom
| | - Vivien Prior
- Institute of Child Health, University College London, London, United Kingdom
| | - Victoria Allgar
- Hull York Medical School, University of York, York, United Kingdom
| | - David Marshall
- Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Jamie Barrow
- Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Natalie Kirby
- Hull York Medical School, University of York, York, United Kingdom
- Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Megan Garside
- Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Pulkit Kaushal
- Tees, Esk and Wear Valley NHS Foundation Trust, York, United Kingdom
| | - Amanda Perry
- Department Health Sciences, University of York, York, United Kingdom
| | - Dean McMillan
- Department Health Sciences, University of York, York, United Kingdom
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20
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Wright B, Edginton E. Evidence-Based Parenting Interventions to Promote Secure Attachment: Findings From a Systematic Review and Meta-Analysis. Glob Pediatr Health 2016; 3:2333794X16661888. [PMID: 27583298 PMCID: PMC4995667 DOI: 10.1177/2333794x16661888] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/22/2016] [Indexed: 11/22/2022] Open
Abstract
Various interventions are used in clinical practice to address insecure or disorganized attachment patterns and attachment disorders. The most common of these are parenting interventions, but not all have a robust empirical evidence base. We undertook a systematic review of randomized trials comparing a parenting intervention with a control, where these used a validated attachment instrument, in order to evaluate the clinical and cost-effectiveness of interventions aiming to improve attachment in children with severe attachment problems (mean age <13 years). This article aims to inform clinicians about the parenting interventions included in our systematic review that were clinically effective in promoting secure attachment. For completeness, we also briefly discuss other interventions without randomized controlled trial evidence, identified in Patient Public Involvement workshops and expert groups at the point our review was completed as being used or recommended. We outline the key implications of our findings for clinical practice and future research.
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Affiliation(s)
- Barry Wright
- Hull York Medical School, University of York, York, UK
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Elizabeth Edginton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
- Anna Freud Centre and University College, London, UK
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