Karine Dubois-Comtois

Efficacy of a home-visiting intervention aimed at improving maternal sensitivity, child attachment, and behavioral outcomes for maltreated children: A randomized control trial

The efficacy of a short-term attachment-based intervention for changing risk outcomes for children of maltreating families was examined using a randomized control trial. Sixty-seven primary caregivers reported for maltreatment and their children (1-5 years) were randomly assigned to an intervention or control group. The intervention group received 8 weekly home visits directed at the caregiver-child dyad and focused on improving caregiver sensitivity. Intervention sessions included brief discussions of attachment-emotion regulation-related themes and video feedback of parent-child interaction. Comparison of pre- and posttest scores revealed significant improvements for the intervention group in parental sensitivity and child attachment security, and a reduction in child disorganization. Older children in the intervention group also showed lower levels of internalizing and externalizing problems following intervention. This is the first study to demonstrate the efficacy of short-term attachment-based intervention in enhancing parental sensitivity, improving child security, and reducing disorganization for children in the early childhood period.

Stability of attachment during the preschool period.

Childrens attachment patterns at early preschool age and 2 years later as well as factors related to stability-instability were examined in a diverse socioeconomic status French Canadian sample of 120 children. Attachment was assessed during 2 laboratory visits using separation-reunion procedures when the children were approximately 3.5 (J. Cassidy & R. S. Marvin, 1992) and 5.5 (M. Main & J. Cassidy, 1988) years old. Overall, stability of attachment, based on 4-way classification, was moderate (68%, k = .47, p = .01). Change from security to disorganization was associated with the most dramatic decline in interactive quality with mother, lowest marital satisfaction, and greatest likelihood of severe attachment-related family events, namely, loss and parental hospitalization. Families of children who changed from security to organized insecurity presented levels of caregiving and marital dissatisfaction that fell between those of stable secure children and secure children who changed toward disorganization.

Attachment-Based Intervention for Maltreating Families

This article presents attachment theory-based intervention strategies as a means of addressing the core parent-child interaction deficits that characterize homes in which children are exposed to maltreatment. The article outlines the socioemotional and cognitive outcomes of maltreatment and proposes that although many prevention programs target different parental and family characteristics, few address the core relationship issues that are at stake. Recent research on attachment-based intervention strategies, aimed at improving the sensitivity and responsiveness of the parenting behaviors that children are exposed to, are presented as providing a means of addressing this domain. Attachment theory and research are briefly summarized, and the relational and interactional patterns observed in maltreating families, and their link to infant and child developmental outcome, are described. Research on attachment-based intervention is addressed, with a focus on studies conducted in the context of maltreating or high-risk families. This work is synthesized to present the basic components viewed as critical to effective attachment intervention with maltreating families. Finally, the authors end with recommendations aimed at the effective implementation of attachment-based intervention.

Attachment behavior and mother-child conversations as predictors of attachment representations in middle childhood: A longitudinal study

This study examines longitudinal links between mother–child conversations and attachment patterns in early childhood and later attachment representations. It also tests the role of conversations as mediators in the association between behavioral security and attachment representations. Mother–child conversations (snack-time) and attachment behaviors (Separation-Reunion procedure) were assessed for 83 5.5-year-olds while attachment representations (attachment narratives) were measured at 8.5 years of age. Results showed correspondence between attachment behaviors and representations for secure-confident, ambivalent-preoccupied, and disorganized/controlling-frightened groups. Affective quality of mother–child conversations predicted both child attachment behaviors and representations. Secure and confident children showed greater integration of affective information, ambivalent and preoccupied children more affect exaggeration, and disorganized/controlling and frightened children more chaotic conversations. Avoidant children tended to show more affect minimization in conversations. Finally, mother–child conversations centered on the sharing of emotions and thoughts mediated the relation between behavioral and representational attachment security, which underscores the importance of mother–child conversations in the development of attachment representations in childhood.

Beyond the dyad: do family interactions influence children's attachment representations in middle childhood?

This study examines the influence of mother–child and family interactions on the development of child attachment representations in middle childhood for a sample of 49 families. Mother–child interactions were observed during a snacktime in a lab setting (Moss, Rousseau, Parent, St-Laurent, & Saintonge, 1998) when children were 5–6 years old. Three years later, childrens attachment representations were assessed using a doll play narrative procedure (Solomon, George, & DeJong, 1995) in the lab setting. Within 6 months of the second lab visit, family interactions were filmed during mealtime and coded using the Mealtime Interaction Coding System (MICS; Dickstein, Hayden, Schiller, Seifer, & San Antonio, 1994). Results showed clear differences between attachment groups on quality of mother–child and family interaction with the secure/confident group showing highest and the disorganized/frightened group showing lowest quality interactions. Family interactions predicted childrens attachment representations, after controlling variance explained by prior mother–child interactions.

Video-feedback intervention with maltreating parents and their children: program implementation and case study

This article describes a video-feedback intervention program with maltreating parents and their children aged 1 to 5 years using a case-study approach. The 8-week program is of interest to researchers and clinicians because it is the first short-term attachment-based intervention program to demonstrate efficacy in enhancing parental sensitivity, improving child attachment security, and reducing disorganized attachment for children and parents who have been reported for child abuse and/or neglect. We have previously described the theoretical and empirical basis of the intervention program and evidence for its efficacy. Details of program implementation and a case study are currently presented.

Transmission of Attachment at Preschool-Age: The Mediating Role of Mother-Child Conversation Styles

Objective: Parents initiate conversations with their preschoolers about everyday experiences in which they share thoughts, feelings, and intentions. The ability to efficiently treat attachment relevant-information and organize attachment behavior beyond infancy is likely to be scaffolded by the parent in the context of parent-child discourse. The objective of this study was to examine mother-child conversation styles as a function of child attachment and test the the role of mother-child conversation as a mediator in the transmission of attachment from mother to child. Methods: The sample included 111 dyads of mothers and their preschool children (3-5 years of age). Child attachment was assessed using the Preschool Attachment Coding System. Mothers’ attachment state of mind was coded using the Adult Attachment Projective. Mother-child conversation styles were assessed during a 10-minute snack time. Results: Analyses indicated a significant correspondence between maternal and child attachment classifications. Moreover, autonomous mothers and secure children were more inclined to integrate affective information during verbal exchanges, while dyads involved in insecure avoidant, ambivalent, or disorganized relationships were more inclined to minimize, exaggerate, or be overwhelmed with affective information. Finally, children’s ability to integrate affective information mediated the link between mother and child attachment security. Conclusion: Overall, results emphasize the importance of the quality of mother-child conversation for the development of internal working models of child attachment during the preschool period. In addition, results are also informative for the development of attachment-based intervention for parents and their preschoolers.

Testing the limits: Extending attachment-based intervention effects to infant cognitive outcome and parental stress

Using a sample of 41 infants and toddlers (21 interventions, 20 controls) who were neglected or at serious risk for neglect, this randomized clinical trial examined the efficacy of a parent-child attachment-based video-feedback intervention on parental sensitivity, parental stress, and child mental/psychomotor development. Results showed that following the 8-week intervention, scores for maternal sensitivity and child mental and psychomotor development were higher in the intervention group than in the control group. The intervention appears to have no effect on self-reports of stress. All parents report lower levels of stress postintervention; however, when defensive responding is not considered (i.e., extremely low score of parental stress), parents in the control group report somewhat lower scores, raising questions as to the significance of this finding. Considering the small nature of our sample, replication of the present results is needed. Nevertheless, the present findings contribute to the burgeoning literature suggesting that the early attachment relationship provides an important context that influences developmental outcome in different spheres and raises questions as to how such intervention strategies may or may not affect the subjective experience of parenting.

Poor Quality of Sleep in Foster Children Relates to Maltreatment and Placement Conditions

This exploratory study investigated child sleep in a sample of maltreated children living in foster care and examined its associations with placement conditions and history of maltreatment. Participants included 25 foster children and their foster caregiver. Children were on average 60.24 months of age (SD = 18.70). Foster mothers completed questionnaires assessing parenting stress and quality of child sleep while maltreatment/placement history was retrieved from children Child Protection Services (CPS) records. Shorter nocturnal sleep duration and parasomnias were related to placement at a younger age. The non-restorative sleep index was significantly related to time spent in the foster home and parenting stress and marginally related to number of placements and sexual abuse and neglect. Poor sleep was associated with past experience of sexual abuse and neglect and parenting stress. No relationships were found between sleep characteristics and past experiences of physical abuse or type of foster family. These findings provide an opportunity to uncover how foster children experiences are related to sleep disturbances.

Attachment Theory in the Assessment and Promotion of Parental Competency in Child Protection Cases

© 2012 Cyr et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Attachment Theory in the Assessment and Promotion of Parental Competency in Child Protection Cases