The relative efficacy of two interventions in altering maltreated preschool children's representational models: Implications for attachment theory

Abstract

A narrative story-stem task was used to evaluate the efficacy of two competing, developmentally informed preventive interventions for maltreated preschoolers and their mothers designed to modify children's internal representations of self and of self in relation to other. One hundred and twenty-two mothers and their preschoolers (87 maltreated and 35 nonmaltreated) served as participants. Maltreating families were randomly assigned to either the preschooler–parent psychotherapy (PPP, n = 23), psychoeducational home visitation (PHV, n = 34), or community standard (CS, n = 30) intervention group at baseline. Thirty-five nonmaltreating (NC) families served as comparisons. Narratives were administered to children at baseline and at the postintervention evaluation. Children in the PPP intervention evidenced more of a decline in maladaptive maternal representations over time than PHV and CS children and displayed a greater decrease in negative self-representations than CS, PHV, and NC children. Also, the mother–child relationship expectations of PPP children became more positive over the course of the intervention, as compared to NC and PHV participants. These results suggest that an attachment-theory informed model of intervention (PPP) is more effective at improving representations of self and of caregivers than is a didactic model of intervention directed at parenting skills. Findings are discussed with respect to their implications for developmental theory, with a specific focus on attachment theory and internal working models of relationships.

Clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems: a systematic review and meta-analysis

“…In total, 30 studies were identified, 175,178,[180][181][182][183][184]188,189,191,[194][195][196]198,[200][201][202][203][205][206][207][208]211,212,218 29 of which were delivering an intervention in a hypothesised 'at-risk' group to improve attachment security 129,[175][176][177][178][180][181][182][183][184][185][186]189,191,[194][195][196]198,[200][201][202][203]205,206,208,211,…”

“…188 The studies were published between 1985 and 2012 and were undertaken in a variety of countries: five in the UK, 176,188,189,207,208 14 in the USA, 177,[180][181][182][184][185][186]191,194,196,200,201,205,211 three in the Netherlands, 178,198,203 three in Canada, 175,195,218 one in Germany, 202 one in Australia, 130 one in Italy, 206 one in Finland 212 and one in Lithuania. 183 l Eight studies were identified in the main systematic review that evaluated the intervention using a measure that assessed a disorganised pattern.…”

“…187 l The remaining 21 studies evaluated the interventions with a measure that assessed only secure and insecure attachment patterns without a disorganised group. 129,[175][176][177][178][180][181][182][183][184][185][186][201][202][203][204][205][206][207][208][209]211 The characteristics of the populations in each study were described and classified into nine categories based on the reporting of authors' population descriptions and/or inclusion criteria. Figure 6 shows the distribution of the population characteristics across the 30 included studies.…”

“…This is to say not that there is no association, but that the evidence to support it is sparse. Specifically, one study 184 attempts to report the effect of attachment problems on IQ as a secondary outcome (but the study reports no significant difference in IQ). No studies were identified to indicate that severe attachment problems have any effect on educational outcomes or are linked to risk of criminality.…”

Child Maltreatment, Adolescent Attachment Style, and Dating Violence: Considerations in Youths with Borderline-to-Mild Intellectual Disability

“…The goals of CPP are threefold: increase reciprocity in the parent-child relationship, improve emotion regulation in the child and the parent, and address posttraumatic stress symptoms (Busch and Lieberman, 2007). After receiving CPP, mothers show higher levels of empathy and interactiveness with their children and children demonstrate an increase in attachment security and less disorganized behavior (Lieberman et al, 1991;Toth et al, 2002). Unfortunately, existing attachment-based interventions tend to focus on very young children (Bakermans-Kranenburg et al, 2003;Cohen et al, 1999), and there is continued need for interventions to address the needs of older children and adolescents.…”