Effect of the Attachment and Child Health Parent Training Program on Parent–Child Interaction Quality and Child Development

Abstract

Background

Exposure to chronic stressors (poverty, addiction, family violence) in early life can derail children’s development. Interventions focused on parental reflective function may promote parents’ abilities to regulate their feelings and behaviors toward their children and buffer the impact of chronic stressors on children’s development by nurturing high-quality parent–child interaction.

Purpose

To test the effectiveness of parental reflective function-focused intervention entitled Attachment and Child Health on parent–child interaction and child development.

Methods

We conducted two pilots with vulnerable mothers and children <36 months. Randomized controlled trial (n = 20) and quasi-experimental (n = 10) methods tested the effect of Attachment and Child Health on parent–child interaction via Parent–Child Interaction Teaching Scale (PCITS) and on child development via Ages and Stages Questionnaire (ASQ-3) and Ages and Stages Questionnaire—Social Emotional (ASQSE). We employed analysis of covariance and t-tests to examine the outcomes.

Results

For randomized controlled trial, we found significant improvements in PCITS parent total, combined total, and cognitive growth fostering scores, and ASQ-3 personal-social scores post-intervention. For quasi-experimental study, we found significant improvements in PCITS combined total, sensitivity to cues, response to child’s distress, and responsiveness to caregiver scores.

Conclusion

Incorporating Attachment and Child Health contributed to effective programming for vulnerable families with young children.

Keywords

Parental reflective function parent–child interaction quality child development pilot interventions

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References

Baradon

Fonagy

Bland

Lénárd

Sleed

(2008). New Beginnings—An experience-based programme addressing the attachment relationship between mothers and their babies in prisons. Journal of Child Psychotherapy, 34(2), 240–258. doi:10.1080/00754170802208065

Bavolek

S. J.

(2000). The nurturing parenting programs. Washington, DC: US Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.

Brakenhoff

Slesnick

(2018). Substance using mothers experiencing suicidal thoughts: Impact of parenting behaviors on child behavior problems. Journal of Child and Family Studies, 27(2), 629–638. doi:10.1007/s10826-017-0897-z

Camoirano

(2017). Mentalizing makes parenting work: A review about parental reflective functioning and clinical interventions to improve it. Frontiers in Psychology, 8, 14. doi:10.3389/fpsyg.2017.00014

Campbell

D. T.

Stanley

J. C.

(2015). Experimental and quasi-experimental designs for research. Baltimore, MA: Ravenio Books.

Shonkoff, J. P., Richmond, J., Levitt, P., Bunge, S. A., Cameron, J. L., Duncan, G. J., & Nelson III, C. A. (2016). From best practices to breakthrough impacts a science-based approach to building a more promising future for young children and families. Cambridge, MA: Harvard University, Center on the Developing Child.

Center on the Developing Child. (2016). From best practices to breakthrough impacts: A science-based approach to building a more promising future for young children and families. Boston, MA: Center on the Developing Child, Harvard University. Retrieved from http://46y5eh11fhgw3ve3ytpwxt9r.wpengine.netdna-cdn.com/wp-content/uploads/2016/05/From_Best_Practices_to_Breakthrough_Impacts-4.pdf

Cohen

(1992). A power primer. Psychological Bulletin, 112(1), 155–159. doi:10.1037/0033-2909.112.1.155

Cox

J. L.

Holden

J. M.

Henshaw

(2014). Perinatal mental health: The Edinburgh Postnatal Depression Scale (EPDS) manual (2nd ed.). London, England: RCPsych Publications.

10.

Cox

J. L.

Holden

J. M.

Sagovsky

(1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782–786. doi:10.1192/bjp.150.6.782

11.

Curley

J. P.

Champagne

F. A.

(2016). Influence of parental care on the developing brain: Mechanisms, temporal dynamics and sensitive periods. Frontiers in Neuroendocrinology, 40, 52–66. doi:10.1016/j.yfrne.2015.11.001

12.

De Falco

Emer

Martini

Rigo

Pruner

Venuti

(2014). Predictors of mother–child interaction quality and child attachment security in at-risk families. Frontiers in Psychology, 5, 898. doi:10.3389/fpsyg.2014.00898

13.

Doig

G. S.

Simpson

(2005). Randomization and allocation concealment: A practical guide for researchers. Journal of Critical Care, 20(2), 187–191. doi:10.1016/j.jcrc.2005.04.005

14.

Eldridge

S. M.

Lancaster

G. A.

Campbell

M. J.

Thabane

Hopewell

Coleman

C. L.

Bond

C. M.

(2016). Defining feasibility and pilot studies in preparation for randomised controlled trials: Development of a conceptual framework. PLoS One, 11(3), e0150205. doi:10.1371/journal.pone.0150205

15.

Farrow

Blissett

(2014). Maternal mind-mindedness during infancy, general parenting sensitivity and observed child feeding behavior: A longitudinal study. Attachment & Human Development, 16(3), 230–241. doi:10.1080/14616734.2014.898158

16.

Firk

Dahmen

Lehmann

Niessen

Koslowski

Rauch

Herpertz-Dahlmann

(2015). A mother-child intervention program in adolescent mothers and their children to improve parental sensitivity, child responsiveness and child development (the TeeMo study): Study protocol for a randomized controlled trial. Trials, 16(1), 230–239. doi:10.1186/s13063-015-0747-5

17.

Fonagy

P. G.

Jurist

Target

E. M.

(2002). Affect regulation, mentalization, and the development of the self. New York, NY: Routledge.

18.

Fonagy

P. G.

Sleed

Baradon

(2016). Randomized controlled trial of parent–infant psychotherapy for parents with mental health problems and young infants. Infant Mental Health Journal, 37(2), 97–114. doi:10.1002/imhj.21553

19.

Fonagy

P. G.

Steele

Moran

G. S.

Higgitt

A. C.

(1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12(3), 201–218. doi:10.1002/1097-0355(199123)12:3%3C201::AID-IMHJ2280120307%3E3.0.CO;2-7

20.

Forman

D. R.

O’hara

M. W.

Stuart

Gorman

L. L.

Larsen

K. E.

Coy

K. C.

(2007). Effective treatment for postpartum depression is not sufficient to improve the developing mother–child relationship. Development and Psychopathology, 19(2), 585–602. doi:10.1017/S0954579407070289

21.

Fosco

G. M.

DeBoard

R. L.

Grych

J. H.

(2007). Making sense of family violence: Implications of children's appraisals of interparental aggression for their short-and long-term functioning. European Psychologist, 12(1), 6–16. doi:10.1027/1016-9040.12.1.6

22.

Gershoff

E. T.

(2016). Should parents’ physical punishment of children be considered a source of toxic stress that affects brain development? Family Relations, 65(1), 151–162. doi:10.1111/fare.12177

23.

Graham-Bermann

S. A.

Gruber

Howell

K. H.

Girz

(2009). Factors discriminating among profiles of resilience and psychopathology in children exposed to intimate partner violence (IPV). Child Abuse & Neglect, 33(9), 648–660. doi:10.1016/j.chiabu.2009.01.002

24.

Gross

Beeber

DeSocio

Brennaman

(2016). Toxic stress: Urgent action needed to reduce exposure to toxic stress in pregnant women and young children. Nursing Outlook, 64(5), 513–515. doi:10.1016/j.outlook.2016.07.011

25.

Grych

J. H.

Fincham

F. D.

Jouriles

E. N.

McDonald

(2000). Interparental conflict and child adjustment: Testing the mediational role of appraisals in the cognitive‐contextual framework. Child Development, 71(6), 1648–1661. doi:10.1111/1467-8624.00255

26.

Hambrick

Perry

Brandt

Hofmeister

Collinsb

(2018). Beyond the ACE score: Examining relationships between timing of developmental adversity, relational health and developmental outcomes in children. Archives of Psychiatric Nursing, 33, 238–247. doi:10.1016/j.apnu.2018.11.001

27.

Hans

S. L.

Bernstein

V. J.

Henson

L. G.

(1999). The role of psychopathology in the parenting of drug-dependent women. Development and Psychopathology, 11(4), 957–977. doi:10.1017/s0954579499002400

28.

Hser

Y. I.

Lanza

H. I.

Kahn

Evans

Schulte

(2015). Maternal mental health and children’s internalizing and externalizing behaviors: Beyond maternal substance use disorders. Journal of Child and Family Studies, 24(3), 638–648. doi:10.1007/s10826-013-9874-3

29.

Humeniuk

Ali

(2006). Validation of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and pilot brief intervention: A technical report of phase II findings of the WHO ASSIST project. Geneva, Switzerland: WHO Press. Retrieved from http://www.who.int/substance_abuse/activities/assist_technicalreport_phase2_final.pdf

30.

Kelly

J. F.

Zuckerman

Rosenblatt

(2008). Promoting first relationships: A relationship‐focused early intervention approach. Infants & Young Children, 21(4), 285–295. doi:10.1097/01.IYC.0000336541.37379.0e

31.

Kendall, S., Nash, A., Braun, A., Bastug, G., Rougeaux, E., & Bedford, H. (2019). Acceptability and understanding of the Ages & Stages Questionnaires®, as part of the Healthy Child Programme 2-year health and development review in England: Parent and professional perspectives. Child: care, health and development, 45(2), 251–256. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/cch.12639

32.

Komro

K. A.

Flay

B. R.

Biglan

, & Promise Neighborhoods Research Consortium. (2011). Creating nurturing environments: A science-based framework for promoting child health and development within high-poverty neighborhoods. Clinical Child and Family Psychology Review, 14(2), 111–134. doi:10.1007/s10567-011-0095-2

33.

Letourneau

Anis

Steele

Hart

(in press). Attachment & Child Health (ATTACH™) pilot trials: Effect of parental reflective function intervention for families affected by toxic stress. Infant Mental Health Journal.

34.

Letourneau

Tryphonopoulos

Giesbrecht

Dennis

C. L.

Bhogal

Watson

(2015). Narrative and meta-analytic review of interventions aiming to improve parental-child attachment security. Infant Mental Health Journal, 36(4), 366–387. doi:10.1002/imhj.21525

35.

Levendosky

A. A.

Bogat

G. A.

Bernard

Garcia

(2018). The effects of intimate partner violence on the early caregiving system. In Motherhood in the face of trauma (pp. 39–54). Cham, Switzerland: Springer. doi:10.1007/978-3-319-65724-0_3

36.

Levendosky

A. A.

Huth-Bocks

A. C.

Shapiro

D. L.

Semel

M. A.

(2003). The impact of domestic violence on the parental-child relationship and preschool-age children’s functioning. Journal of Family Psychology, 17(3), 275–287. doi:10.1037/0893-3200.17.3.275

37.

Levendosky

A. A.

Leahy

K. L.

Bogat

G. A.

Davidson

W. S.

von Eye

(2006). Domestic violence, maternal parenting, maternal mental health, and infant externalizing behavior. Journal of Family Psychology, 20(4), 544–552. doi:10.1037/0893-3200.20.4.544

38.

Leyton

Olhaberry

Alvarado

Rojas

Dueñas

L. A.

Downing

Steele

(2019). Video feedback intervention to enhance parental reflective functioning in primary caregivers of inpatient psychiatric children: Protocol for a randomized feasibility trial. Trials, 20(1), 268. doi:10.1186/s13063-019-3310-y

39.

Liu

Kaaya

Chai

McCoy

D. C.

Surkan

P. J.

Black

M. M.

Smith-Fawzi

M. C.

(2016). Parental depressive symptoms and early childhood cognitive development: A meta-analysis. Psychological Medicine, 47(4), 680–689. doi:10.1017/S003329171600283X

40.

Mackrides

P. S.

Ryherd

S. J.

(2011). Screening for developmental delay. American Family Physician, 84(5), 544–549. Retrieved from http://www.aafp.org/afp/2011/0901/p544.html

41.

McManus

B. M.

Poehlmann

(2012). Parent–child interaction, parental depressive symptoms and preterm infant cognitive function. Infant Behavior and Development, 35(3), 489–498. doi:10.1016/j.infbeh.2012.04.005

42.

Meins

Fernyhough

de Rosnay

Arnott

Leekam

S. R.

Turner

(2012). Mind‐mindedness as a multidimensional construct: Appropriate and nonattuned mind‐related comments independently predict infant–mother attachment in a socially diverse sample. Infancy, 17(4), 393–415. doi:10.1111/j.1532-7078.2011.00087.x

43.

Meins

Fernyhough

Wainwright

Clark-Carter

Das Gupta

, . . . Tuckey

(2003). Pathways to understanding mind: Construct validity and predictive validity of maternal mind‐mindedness. Child Development, 74(4), 1194–1211. doi:10.1111/1467-8624.00601

44.

Meins

Fernyhough

Wainwright

Das Gupta

Fradley

Tuckey

(2002). Maternal mind–mindedness and attachment security as predictors of theory of mind understanding. Child Development, 73(6), 1715–1726. doi:10.1111/1467-8624.00501

45.

Midgley

Vrouva

(Eds.). (2012). Minding the child: Mentalization-based interventions with children, young people and their families. New York, NY: Routledge.

46.

Ordway

M. R.

Webb

Sadler

L. S.

Slade

(2015). Parental reflective functioning: An approach to enhancing parent-child relationships in pediatric primary care. Journal of Pediatric Health Care, 29(4), 325–334. doi:10.1016/j.pedhc.2014.12.002

47.

Righetti-Veltema

Bousquet

Manzano

(2003). Impact of postpartum depressive symptoms on mother and her 18-month-old infant. European Child & Adolescent Psychiatry, 12(2), 75–83. doi:10.1007/s00787-003-0311-9

48.

Rostad

W. L.

Whitaker

D. J.

(2016). The association between reflective functioning and parent–child relationship quality. Journal of Child and Family Studies, 25(7), 2164–2177. doi:10.1007/s10826-016-0388-7

49.

Rutherford

H. J.

Maupin

A. N.

Landi

Potenza

M. N.

Mayes

L. C.

(2017). Parental reflective functioning and the neural correlates of processing infant affective cues. Social Neuroscience, 12(5), 519–529. doi:10.1080/17470919.2016.1193559

50.

Sadler

L. S.

Slade

Webb

D. L.

Simpson

Fennie

Mayes

L. C.

(2013). Minding the baby: Enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home‐visiting program. Infant Mental Health Journal, 34(5), 391–405. doi:10.1002/imhj.21406

51.

Sayre

J. M.

Pianta

R. C.

Marvin

R. S.

Saft

E. W.

(2001). Mothers’ representations of relationships with their children: Relations with mother characteristics and feeding sensitivity. Journal of Pediatric Psychology, 26(6), 375–384. doi:10.1093/jpepsy/26.6.375

52.

Slade

Sadler

L. S.

Mayes

L. C.

(2005). Minding the baby: Enhancing parental reflective functioning in a nursing/mental health home visiting program. Infant Mental Health Journal, 35(5), 1–28. doi:10.1002/imhj.21406

53.

Sleed

Baradon

Fonagy

(2013). New Beginnings for mothers and babies in prison: A cluster randomized controlled trial. Attachment & Human Development, 15(4), 349–367. doi:10.1080/14616734.2013.782651

54.

Smaling

H. J.

Huijbregts

S. C.

Suurland

van der Heijden

K. B.

Mesman

van Goozen

S. H.

Swaab

(2016). Prenatal reflective functioning and accumulated risk as predictors of maternal interactive behavior during free play, the still‐face paradigm, and two teaching tasks. Infancy, 21(6), 766–784. doi:10.1111/infa.12137

55.

Squires

Bricker

(2009). Ages & stages questionnaires®, third edition (ASQ®-3): A parent-completed child monitoring system (3rd ed.). Baltimore, MD: Paul H Brookes Publishing Company.

56.

Squires

Bricker

Twombly

(2002). The ASQ: SE user’s guide: For the ages & stages questionnaires: Social-emotional. Baltimore, MD: Paul H Brookes Publishing Company.

57.

Stacks

A. M.

Muzik

Wong

Beeghly

Huth-Bocks

Irwin

J. L.

Rosenblum

K. L.

(2014). Maternal reflective functioning among mothers with childhood maltreatment histories: Links to sensitive parenting and infant attachment security. Attachment & Human Development, 16(5), 515–533. doi:10.1080/14616734.2014.935452

58.

Straus

M. A.

Hamby

S. L.

Boney-McCoy

Sugarman

D. B.

(1996). The revised conflict tactics scales (CTS2) development and preliminary psychometric data. Journal of Family Issues, 17(3), 283–316. doi:10.1177/019251396017003001

59.

Suchman

N. E.

DeCoste

Castiglioni

Legow

Mayes

(2008). The Mothers and Toddlers Program: Preliminary findings from an attachment-based parenting intervention for substance-abusing mothers. Psychoanalytic Psychology, 25(3), 499. doi:10.1037/0736-9735.25.3.499

60.

Suchman

N. E.

DeCoste

Castiglioni

McMahon

T. J.

Rounsaville

Mayes

(2010a). The Mothers and Toddlers Program, an attachment-based parenting intervention for substance using women: Post-treatment results from a randomized clinical pilot. Attachment & Human Development, 12(5), 483–504. doi:10.1080/14616734.2010.501983

61.

Suchman

N. E.

DeCoste

Leigh

Borelli

(2010b). Reflective functioning in mothers with drug use disorders: Implications for dyadic interactions with infants and toddlers. Attachment & Human Development, 12, 567–585. doi:10.1080/14616734.2010.501988

62.

Suchman

N. E.

Luthar

S. S.

(2000). Maternal addiction, child maladjustment and socio‐demographic risks: Implications for parenting behaviors. Addiction, 95(9), 1417–1428. doi:10.1046/j.1360-0443.2000.959141711.x

63.

Suchman

N. E.

Rounsaville

DeCoste

Luthar

(2007). Parental control, parental warmth, and psychosocial adjustment in a sample of substance-abusing mothers and their school-aged and adolescent children. Journal of Substance Abuse Treatment, 32(1), 1–10. doi:10.1016/j.jsat.2006.07.002

64.

Sumner

Spietz

(1994). NCAST caregiver/child feeding and teaching manuals. Seattle, WA: NCAST Publications, University of Washington.

65.

Torrado

M. V.

Ouakinin

S. S.

Bacelar-Nicolau

(2013). Alexithymia, emotional awareness and perceived dysfunctional parental behaviors in heroin dependents. International Journal of Mental Health and Addiction, 11(6), 703–718. doi:10.1007/s11469-013-9448-z

66.

World Health Organization ASSIST Working Group. (2002). The alcohol, smoking and substance involvement screening test (ASSIST): Development, reliability and feasibility. Addiction, 97(9), 1183–1194. doi:10.1046/j.1360-0443.2002.00185.x