Effect of Attachment and Child Health (ATTACHTM) Parenting Program on Parent-Infant Attachment, Parental Reflective Function, and Parental Depression

Abstract

High-risk families exposed to toxic stressors such as family violence, depression, addiction, and poverty, have shown greater difficulty in parenting young children. In this study, we examined the effectiveness of ATTACHTM, a 10–12 session manualized one-on-one parental Reflective Function (RF)-based parenting program designed for high-risk families. Outcomes of parent-child attachment and parental RF were assessed via the Strange Situation Procedure (SSP) and Reflective Function Scale (RFS), respectively. The protective role of ATTACHTM on parental depression was also assessed. Data were available from caregivers and their children < 6 years of age who participated in five pilot randomized control trials (RCTs) and quasi-experimental studies (QES; n = 40). Compared with the control group, caregivers who received the ATTACHTM-program demonstrated a greater likelihood of secure attachment with their children (p = 0.004) and higher parental RF [self (p = 0.004), child (p = 0.001), overall (p = 0.002)] in RCTs. A significant improvement in parental RF (p = 0.000) was also observed in the QES within ATTACH™ group analysis. As attachment security increased, receiving the ATTACHTM program may be protective for depressed caregivers. Results demonstrated the promise of ATTACH™ for high-risk parents and their young children.

Impacts of the Attachment and Child Health (ATTACHTM) Parenting Program on Mothers and Their Children at Risk of Maltreatment: Phase 2 Results

“…The ATTACH TM intervention is a brief parenting psycho-educational intervention with dyadic (mother/primary caregiver and infant) and triadic (mother/primary caregiver, infant, and co-parenting support person) components that foster parental RF [ 26 , 45 , 89 ]. The intervention is designed to help parents enhance and develop their capacity for RF (or mentalizing).…”

“…A recent systemic review [ 36 ] of dyadic interventions targeting improvement in parental RF reported a significant reduction in disorganized attachment in infants (risk ratio: 0.50; 95% CI [0.27, 0.90]) [ 36 ]. Parental RF interventions also improved RF for mothers experiencing addiction [ 27 , 37 , 38 , 39 , 40 ], imprisonment [ 42 , 43 , 44 ], depression, family violence, and/or poverty [ 11 , 26 , 45 ]. Despite variations in intervention design, sample size, and coding methods for assessing parental RF, RF interventions appear to enhance maternal RF in high-risk families [ 46 ].…”

“…Parental RF-based parenting interventions may be among the most effective strategies to help vulnerable families facing adversities that put infants/children at risk for maltreatment and associated poor outcomes [ 11 , 26 , 36 , 45 , 88 ]. One such intervention is the Attachment and Child Health (ATTACH TM ) program, a psycho-educational intervention designed to improve children’s development, health, and relationship outcomes [ 11 , 26 , 45 , 89 , 90 ]. ATTACH TM has been recognized as one of Harvard University’s Frontier of Innovation Projects [ 91 ].…”

“…ATTACH TM has been recognized as one of Harvard University’s Frontier of Innovation Projects [ 91 ]. Phase 1 findings from the evaluations of ATTACH™-employing randomized controlled trials (RCTs) and quasi-experimental studies (QES) revealed that ATTACH™ significantly improved: (a) parents’ RF [ 26 , 45 ]; (b) parent–child interaction quality [ 11 ]; and (c) children’s development, specifically in the personal social domain [ 11 ]. Data that combined samples across Phase 1 and Phase 2 revealed that intervention improved the likelihood that children were securely attached [ 45 ], and data from one pilot study that collected blood samples in Phase 2 showed that ATTACH™ improved mothers’ and children’s immune cell gene expression linked to inflammation [ 90 ].…”

Exploring Indigenous Community Conceptions of Parent Wellbeing: A Qualitative Analysis

“…The influences of parent wellbeing on the parent–child dyad [ 1 , 2 , 3 ] and early child development [ 4 , 5 , 6 ] have been explored extensively in the general population. The most commonly researched parent wellbeing indicators include parental depression [ 7 ], trauma [ 8 ], problem gambling [ 9 ], and parental stress [ 10 ].…”