Femmie Juffer

Less Is More: Meta-Analyses of Sensitivity and Attachment Interventions in Early Childhood

Is early preventive intervention effective in enhancing parental sensitivity and infant attachment security, and if so, what type of intervention is most successful? Seventy studies were traced, producing 88 intervention effects on sensitivity (n = 7,636) and/or attachment (n = 1,503). Randomized interventions appeared rather effective in changing insensitive parenting (d = 0.33) and infant attachment insecurity (d = 0.20). The most effective interventions used a moderate number of sessions and a clear-cut behavioral focus in families with, as well as without, multiple problems. Interventions that were more effective in enhancing parental sensitivity were also more effective in enhancing attachment security, which supports the notion of a causal role of sensitivity in shaping attachment.

Experimental Evidence for Differential Susceptibility: Dopamine D4 Receptor Polymorphism (DRD4 VNTR) Moderates Intervention Effects on Toddlers' Externalizing Behavior in a Randomized Controlled Trial.

In a randomized controlled trial we tested the role of genetic differences in explaining variability in intervention effects on child externalizing behavior. One hundred fifty-seven families with 1- to 3-year-old children screened for their relatively high levels of externalizing behavior participated in a study implementing Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), with six 1.5-hr intervention sessions focusing on maternal sensitivity and discipline. A moderating role of the dopamine D4 receptor (DRD4) variable-number tandem repeat (VNTR) exon III polymorphism was found: VIPP-SD proved to be effective in decreasing externalizing behavior in children with the DRD4 7-repeat allele, a polymorphism that is associated with motivational and reward mechanisms and Attention Deficit Hyperactivity Disorder (ADHD) in children. VIPP-SD effects were largest in children with the DRD4 7-repeat allele whose parents showed the largest increase in the use of positive discipline. The findings of this first experimental test of (measured) gene by (observed) environment interaction in human development indicate that children may be differentially susceptible to intervention effects depending on genetic differences.

Adoption and Cognitive Development: A Meta-Analytic Comparison of Adopted and Nonadopted Children's IQ and School Performance.

This meta-analysis of 62 studies (N=17,767 adopted children) examined whether the cognitive development of adopted children differed from that of (a) children who remained in institutional care or in the birth family and (b) their current (environmental) nonadopted siblings or peers. Adopted children scored higher on IQ tests than their nonadopted siblings or peers who stayed behind, and their school performance was better. Adopted children did not differ from their nonadopted environmental peers or siblings in IQ, but their school performance and language abilities lagged behind, and more adopted children developed learning problems. Taken together, the meta-analyses document the positive impact of adoption on the childrens cognitive development and their remarkably normal cognitive competence but delayed school performance.

Maternal sensitivity, infant attachment, and temperament in early childhood predict adjustment in middle childhood: the case of adopted children and their biologically unrelated parents.

In a longitudinal study, internationally adopted children (N = 146) placed before 6 months of age were followed from infancy to age 7. Results showed that girls were better adjusted than boys, except in cognitive development, and that easy temperament was associated with higher levels of social, cognitive, and personality development and fewer behavior problems. Higher quality of child-mother relationships, in terms of attachment security and maternal sensitivity, uniquely predicted better social and cognitive development. The combination of attachment disorganization and difficult temperament predicted less optimal ego-control and lower levels of cognitive development. It is concluded that even in adopted children, who are not biologically related to their adoptive parents, early mother-infant interactions and attachment relationships predict later socioemotional and cognitive development, beyond infant temperament and gender.

Cortisol and externalizing behavior in children and adolescents: mixed meta-analytic evidence for the inverse relation of basal cortisol and cortisol reactivity with externalizing behavior.

An inverse relation between cortisol (re)activity and externalizing behavior has been hypothesized, but research findings seem equivocal. We tested this hypo(re)activity hypothesis in two meta-analyses, one for basal cortisol (k = 72 studies, N = 5,480) and one for cortisol reactivity to a stressor (k = 29 studies, N = 2,601). No association was found between cortisol reactivity and externalizing behaviors (r = -.04, 95% CI = -.11, .02). However, the relation between basal cortisol and externalizing behavior was significant but small (r = -.05, 95% CI = -.10, -.002). The age of the children significantly moderated this relation: Externalizing behavior was associated with higher basal cortisol (hyperactivity) in preschoolers (r = .09, 95% CI = .002, .17), and with lower basal cortisol (hypoactivity) in elementary school-aged children (r = -.14, 95% CI = -.19, -.08). There was no significant relation between cortisol and externalizing behavior in adolescents.

Attachment-Based Intervention for Enhancing Sensitive Discipline in Mothers of 1- to 3-Year-Old Children at Risk for Externalizing Behavior Problems: A Randomized Controlled Trial.

The home-based intervention program Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) was tested in a randomized controlled trial with 237 families screened for their 1- to 3-year-old childrens relatively high scores on externalizing behavior. VIPP-SD, based on attachment theory and coercion theory, focuses on mirroring and discussing actual parent-child interactions in six 1.5-hr sessions with individual families at home. VIPP-SD proved to be effective in enhancing maternal attitudes toward sensitivity and sensitive discipline and in promoting sensitive discipline interactions in the intervention group as compared with the control group. Moreover, in families with more marital discord and in families with more daily hassles, the intervention resulted in a decrease of overactive problem behaviors in the children. The authors conclude that VIPP-SD should become an important module in attachment-based interventions.

Disorganized infant attachment and preventive interventions: a review and meta-analysis

Infant disorganized attachment is a major risk factor for problematic stress management and later problem behavior. Can the emergence of attachment disorganization be prevented? The current narrative review and quantitative meta-analysis involves 15 preventive interventions (N = 842) that included infant disorganized attachment as an outcome measure. The effectiveness of the interventions ranged from negative to positive, with an overall effect size of d = 0.05 (ns). Effective interventions started after 6 months of the infants age (d = 0.23). Interventions that focused on sensitivity only were significantly more effective in reducing attachment disorganization (d = 0.24) than interventions that (also) focused on support and parents mental representations (d = -0.04). Most sample characteristics were not associated with differences in effect sizes, but studies with children at risk were more successful (d = 0.29) than studies with at-risk parents (d = -0.10), and studies on samples with higher percentages of disorganized attachment in the control groups were more effective (d = 0.31) than studies with lower percentages of disorganized children in the control group (d = -0.18). The meta-analysis shows that disorganized attachments may change as a side effect of sensitivity-focused interventions, but it also illustrates the need for interventions specifically focusing on the prevention of disorganization.

Plasticity of growth in height, weight, and head circumference: meta-analytic evidence of massive catch-up after international adoption.

Are serious growth delays caused by malnutrition and neglect permanent or reversible? The effects of institutionalization and international adoption on childrens physical growth are estimated with meta-analysis. Studies with sufficient data to compute differences between adoptees and the reference population (33 papers with 122 study outcomes) were collected through Web of Science, ERIC (Education Resource Information Center), PsycINFO (Psychological Literature), and Medline (U.S. National Library of Medicine) (1956–2006). The influence of pre- and postadoption care on height, weight, and head circumference was tested. Effect sizes (d) and confidence intervals (CIs) around the point estimate for the growth lag indices were computed. The more time spent in institutional care, the more the children lagged behind in physical growth (d = 1.71, 95% CI: 0.82–2.60, n = 893). At adoptive placement, the children showed large delays in height, weight, and head circumference (d = −2.39 to −2.60; n = 1331–3753). Although after adoption, they showed almost complete catch-up of height (d = −0.57, 95% CI: −0.87 to −0.27, n = 3437 adoptees) and weight (d = −0.72, 95% CI: −1.04 to −0,39, n = 3259 adoptees), catch-up of head circumference seemed slower and remained incomplete (d = −1.56, 95% CI: −2.27 to −0.85, n = 527). Later age at arrival was related to less complete catch-up of height and weight. International adoption leads to substantial catch-up of height and weight but not of head circumference, demonstrating differential plasticity of childrens physical growth.

The Development and Adjustment of 7-year-old Children Adopted in Infancy

The present study (N = 159) provides evidence of an increased risk for behavior problems of infant-placed 7-year-old internationally, transracially adopted children in the Netherlands. However, parents reported more behavior problems for adopted boys than for adopted girls. Notably, about 30% of the adopted children were classified as clinical on the CBCL scale for total problems, which is a much larger percentage than the 10% found in the normative population. It was suggested that these results could be explained by the operation of multiple risk factors before and after adoption placement, e.g. the childs genetic disposition, pre-natal and pre-adoption care, or the childs cognitive understanding of adoption in middle childhood. Also, results suggest that maternal sensitive responsiveness in adoptive families declines in the transition from early to middle childhood. In contrast to the home setting, the adopted children showed favorable behavioral and socioemotional adjustment at school, while their academic achievement and intelligence were in the normal range or above average. In particular Korean children had high IQs: 31% of these children obtained an intelligence score above 120. It was suggested that adoptive parents seem to offer their children sufficient or even more than average cognitive stimulation. Furthermore, adopted girls scored higher in optimal ego-control, social competence, and peer group popularity than nonadopted girls from the general population: 30% of the adopted girls were rated as popular by their classmates, which compares favorably to the 13% found in the general school population.

Effects of an attachment-based intervention on daily cortisol moderated by dopamine receptor D4: A randomized control trial on 1- to 3-year-olds screened for externalizing behavior

The effect of the Video-Feedback Intervention to Promote Positive Parenting and Sensitive Discipline (VIPP-SD) on daily cortisol production was tested in a randomized controlled trial with 130 families with 1- to 3-year-old children screened for their relatively high levels of externalizing behavior. Six 1.5-hr intervention sessions focusing on maternal sensitivity and discipline were conducted with individual families at their homes. Children in the intervention group showed lower cortisol levels, with a moderating role of the dopamine receptor D4 (DRD4) VNTR exon III polymorphism. The VIPP-SD program proved to be effective in decreasing daily cortisol production in children with the DRD4 7-repeat allele, but not in children without the DRD4 7-repeat allele. Our findings indicate that children are differentially susceptible to intervention effects dependent on the presence of the 7-repeat DRD4 allele.