Feasibility and efficacy of an attachment-based intervention in a maltreatment sample in residential care: A pilot study

Abstract

The effects of the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline on improving maternal sensitivity and sensitive discipline were investigated using a randomized control design in a pilot sample of mothers at high risk of maltreatment. The study included 12 mothers and their 10- to 36-month-old children placed in parental residential care, due to a guardianship order issued by the Youth Court. Both at pretest and post-test, maternal sensitivity and sensitive discipline were assessed during mother–child interaction via observational measures. Mothers who received the intervention showed a significant reduction in dysfunctional strategies of maternal discipline. Results highlight the usefulness and feasibility of a brief residential care–based intervention in such a risk sample, with promising implications for the prevention of child maltreatment.

Keywords

Video-feedback intervention maternal sensitivity discipline maltreatment

Introduction

Maltreatment arguably represents one of the strongest examples of how environmental circumstances may create marked disturbances in children, thus constituting a crucial public health issue. Indeed, several studies have reported interpersonal, cognitive, emotional, behavioral, psychiatric, and substance abuse problems to be associated with child maltreatment (e.g. Gilbert et al., 2009; Naughton et al., 2013). Anomalous functioning of stress-related biological systems, which in turn can adversely impact childhood brain development, has also been found in maltreated children (e.g. De Bellis & Zisk, 2014; Hart & Rubia, 2012; Macmillan, 2009; Teicher & Samson, 2016). Moreover, there is strong evidence that maltreatment experienced in childhood has devastating long-lasting effects on mental health, increases the risk for delinquent behavior, and affects future parenting competencies (Fang, Brown, Florence, & Mercy, 2012; Meadows, Tunstill, George, Dhudwar, & Kurtz, 2011).

Given the human, social, health-related, and financial costs associated with child maltreatment, preventing maltreatment constitutes one of the most compelling issues worldwide, especially in high-risk contexts where parents may be likely to behave in an abusing or neglecting way. Although it is mandatory to address targeted support to vulnerable families (Eurochild, 2012), few programs that target maltreating parents have been evaluated, especially for those with children in the youngest age range of 0–3 years old. In a recent meta-analysis, significant effects on reducing child maltreatment were found for programs providing parent training. However, more studies using randomized control designs are needed (Euser, Alink, Stoltenborgh, Bakermans-Kranenburg, & van IJzendoorn, 2015).

There is empirical evidence that programs reaching families at risk via home visits decrease the prevalence and risk of maltreatment (Sweet & Appelbaum, 2004), and that programs are more effective if they are carried out by professionals versus laymen (Layzer, Goodson, Bernstein, & Price, 2001). Among intervention models for the prevention of child maltreatment, those focusing on early mother–child interaction were found to significantly improve maternal sensitivity, which was associated with a decline in abuse potential (Thomas & Zimmer-Gembeck, 2012). Sensitivity is a core concept in parenting that refers to parental ability to perceive and correctly interpret child signals, as well as to respond to them promptly and appropriately (Ainsworth, Blehar, Waters, & Wall, 1978). Maternal sensitivity was found to be significantly associated with the promotion of attachment security (Bakermans-Kranenburg, van IJzendoorn, & Juffer, 2003; DeWolff & van IJzendoorn, 1997), self-regulation (e.g. Leerkes, Blankson, & O’Brien, 2009), social functioning (e.g. Kochanska, 2002) and cognitive competence (e.g. Tamis-LeMonda, Bornstein, & Baumwell, 2001). Furthermore, maternal insensitivity represents a risk of negative parenting strategies, as shown by Joosen, Mesman, Bakermans-Kranenburg, and van IJzendoorn (2012), who reported a link between impaired maternal abilities to respond appropriately to infant signals and later harsh discipline. In fact, it is hypothesized that an underlying lack of empathy for the child and inability to understand his or her needs impacts the parental interpretation of the child’s behavior negatively during both normal interactions and discipline situations, thus activating rigid and inadequate responses (Joosen et al., 2012).

A meta-analysis (Bakermans-Kranenburg et al., 2003) showed that short-term preventive interventions with a primary focus on modifying caregiver’s interactive behavior with the child rather than on modifying parental representations were the most effective in promoting maternal sensitivity. However, only a handful of studies have investigated the effects of attachment-based interventions on parental discipline strategies (e.g. Pereira, Negrão, Soares, & Mesman, 2014; Van Zeijl et al., 2006).

The Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD: Juffer, Bakermans-Kranenburg, & van IJzendoorn, 2008) is a behaviorally focused attachment-based parenting intervention program. It is a brief (four to six sessions), home-based intervention aimed at increasing maternal sensitivity and adequate discipline strategies during child–parent interactions using videofeedback (e.g. Juffer & Steele, 2014). This intervention combines the advantages related to a manualized protocol with those associated with an individual, “tailored” treatment for each single case. Furthermore, parent–intervener alliance was found to be modestly associated with increased maternal supportive presence to the child (Stolk et al., 2008), although no inference can be made with regard to the causal direction of this association.

The VIPP has been systematically evaluated through randomized controlled trials in 12 samples (Juffer, Bakermans-Kranenburg, & van IJzendoorn, 2017). These studies have shown VIPP to be effective across many different contexts, such as adoptive families with children at risk of disorganized attachment (Juffer, Bakermans-Kranenburg, & van IJzendoorn, 2005), insensitive mothers (Kalinauskiene et al., 2009), pre-school children showing externalizing behaviors (Van Zeijl et al., 2006; Velderman et al., 2006), mothers with eating disorders (Stein et al., 2006), children with autistic disorders (Poslawsky, Naber, Bakermans-Kranenburg, De Jonge, et al., 2014; Poslawsky, Naber, Bakermans-Kranenburg, van Daalen, et al., 2014), and ethnic minority mothers (Yagmur, Mesman, Malda, Bakermans-Kranenburg, & Ekmekci, 2014). To our knowledge, there is only one study that applied the VIPP-SD to mothers from severely disadvantaged backgrounds, namely, one conducted in Portugal (Negrão, Pereira, Soares & Mesman, 2014; Pereira et al., 2014). Negrão et al. (2014) showed that the intervention enhanced positive parent–child interactions and positive family relations in a poverty sample of mothers with their 1- to 4-year-old children. Moreover, the VIPP-SD was also effective in decreasing maternal harsh parenting, but only among mothers who experienced high levels of parenting stress at intake (Pereira et al., 2014). However, the efficacy of the VIPP-SD has never been tested in a sample with multiple risk factors for child maltreatment, even though a similar videofeedback intervention significantly improved parental sensitivity and child attachment security in a sample of parents who have been reported for child abuse and/or neglect (Moss, Dubois-Comtois, Cyr, Tarabulsy, St-Laurent, & Bernier, 2011).

The present pilot study evaluated the efficacy of the VIPP-SD in an Italian sample of mothers and their children placed in parental residential care due to a guardianship order issued by the Youth Court. Using a randomized control design with pre- and post-test assessments, we tested the hypothesis that the VIPP-SD intervention would be effective in improving maternal sensitivity and positive discipline in this high-risk context. Additionally, we were interested in exploring mother–intervener alliance in this maltreatment high-risk context, as well as its possible association with positive parenting.

Method

Participants and procedure

The initial sample consisted of 13 mother–child dyads recruited from five parental residential care centers for mothers and children receiving protective and educational services for issues related to child maltreatment. All women had a decree of the juvenile court that established that they were unable to provide necessary care for the physical and psychological needs of their children and therefore needed to be monitored by child protection services. To be included in the study, the expected duration of stay in the residential communities had to be longer than 5 months, and knowledge of the Italian language was essential; severe medical conditions for both mother and child (i.e. serious physical impairments, mental retardation, history of psychosis) were exclusion criteria. One mother from the control group participated in all the expected sessions with the exception of the post-test session as the father of the infant withdrew his consent. As no outcome data were available (Gupta, 2011; Hollis & Campbell, 1999), this dyad was excluded from the analyses. The final sample consisted of 12 mother–child dyads.

The extremely disadvantaged and high-risk nature of the sample is reflected by the following socio-demographic characteristics: income below 10,000 Euros per year (100%), maternal unemployment (75%), single parent (67%), low educational level (50% had less than 8 years of education), and being foreigners (67%). Maternal mean age at the pretest was 26.83 years (standard deviation (SD) = 9.52 years; range = 17–46 years) and the mean age of their children (n = 4 boys; n = 8 girls), most of whom were firstborn (75%), was 19.58 months (SD = 9.51 months; range = 10–36 months).

Participants were assessed at baseline in a pretest session at the residential community, during which dyads were videotaped in various mother–child interactive tasks and mothers were asked to fill in an ad hoc socio-demographic form. After the pretest, dyads were randomly assigned to either the intervention group (n = 7) or the control group (n = 5) through a computer-generated list stratified for child’s gender and age. There were no differences between the intervention and control group regarding maternal age (t(10) = −.90; p = .39), maternal education (χ²(1) = 0.34; p = 1.00), child age (t = −.30; p = .77), and child gender (χ²(1) = .69; p = .58), thus confirming the random assignment to the two groups.

Dyads in the intervention group received six visits over a period of 4 months at their community, while participants in the control group, parallel in timing, received six telephone calls. Approximately 2 weeks after the last visit/telephone call, all participants were invited to take part in a post-test session that consisted of the same procedures employed in the pretest.

The study was approved by the Ethics Committee of the Scientific Institute Medea. All mothers and, whenever present, children’s fathers and guardians signed an informed written consent to participate.

The VIPP-SD program

The VIPP-SD (Juffer et al., 2008) is a home-based, short-term intervention, aimed at enhancing maternal sensitivity and positive discipline through the use of videofeedback technique. The VIPP-SD program is based on a standardized protocol of six home visits: the first four visits each have their own themes, tips and exercises for mother and child regarding both sensitivity and discipline. These are scheduled at 2-week intervals. The last two visits, which are 1 month apart, are booster sessions that allow for reviewing themes from the previous sessions.

Each intervention session is composed of two parts. In the first part, the intervener films mother and child during daily situations (e.g. playing together, reading a book, cleaning up) in short episodes of 10–30 minutes. In the second part, the intervener reviews the videos from the previous session with the mother and discusses specific previously selected segments chosen to foster her observational skills and empathy for the child. The intervention themes of the four visits focus on both maternal sensitivity and sensitive discipline. The themes for maternal sensitivity are (1) exploration versus contact seeking, (2) “speaking for the child,” (3) sensitivity, and (4) empathy. The themes for sensitive discipline are (1) inductive discipline and distraction, (2) positive reinforcement, (3) sensitive time-out, and (4) empathy for the child (for a full description, see Juffer et al., 2008).

Interveners are instructed to reinforce positive and appropriate mother–child interactions and effective discipline strategies and to involve mothers in the discussion as “experts” about their own child. Information about the general development of young children is also provided. At the end of the last session, each participant receives a booklet with a summary of the themes, tips and advice given during the video feedback sessions.

In our study, all intervention sessions took place in a familiar environment (i.e. the bedroom of the dyad or the recreation room) at the residential care center where mother and child were currently housed. Each visit lasted approximately 1.5 hours. The only adjustment needed to the VIPP-SD protocol due to our residential placement context was related to the third visit, which typically involves filming during lunch time. As lunch in these residential settings usually occurred in a common room with other mother–child dyads, we substituted it by filming a private snack break in order to guarantee the privacy of all dyads and exclude any external interference.

The VIPP-SD intervention was delivered by two female interveners, one with a master’s degree in Clinical Psychology and the other one with a PhD in Developmental Psychology. Both of them completed the 1-week training in Milan (Italy), were certified as interveners, and received supervision from a VIPP-SD trainer during the intervention phase. All participants assigned to the intervention group attended all the sessions and completed the entire research protocol.

Control condition

Parallel to the intervention group, the mothers in the control group received six telephone calls that were scheduled at the same time intervals as the VIPP-SD sessions. Each phone call involved predefined open questions to the mothers concerning standard topics related to child development, such as play, sleep, feeding, and social relations. The phone calls were always delivered by the same VIPP-SD intervener and lasted approximately 10 minutes. During each phone call, mothers were encouraged to talk about the development of their child, but no tips or advice were provided. Moreover, whenever explicitly asked for advice, interveners redirected mothers to the educators of the residential care center or to their pediatrician. All participants assigned to the control group received all the phone calls scheduled and completed the entire research protocol.

Measures

Maternal sensitivity

Maternal sensitivity was assessed, both at pre- and post-test, during a 10-minute free-play period during which mothers were instructed to interact with their children as they normally did, followed by a 5-minute period where mothers were asked to fill in a questionnaire while the child was free to play.

The 72-item version of the Maternal Behavior Q-Set (MBQS; Pederson & Moran, 1995) was used to rate maternal sensitivity. This instrument is composed of 72 items describing maternal interactive behavior (e.g. “During ongoing interactions, misses slow down or back off signals from B,” “Builds on focus of B’s attention,” “Non-synchronous interactions with B”), and is based on the q-sort technique (Waters & Deane, 1985). Specifically, raters are instructed to assess items as being most-like, neutral or unlike the observed mother, sorting them first into three groups and then into nine groups (8 items in each pile), depending on the degree to which they represent maternal observed behavior. A sensitivity score is then calculated as the correlation between the observer’s sort and a criterion sort describing the prototypically sensitive mother, which is provided by the authors of the MBQS. Scores range from −1.0 (least sensitive) to 1.0 (prototypically sensitive). The ability of the 72-item version of the MBQS to capture the construct of sensitivity more effectively and accurately than other sensitivity measures has been reported (Behrens, Parker, & Haltigan, 2011), as well as its ability to detect meaningful differences in maternal behaviors in various sets of video-recorded interactions (e.g. Atkinson et al., 2005; Behrens et al., 2011).

In the present study, two coders with a master’s degree in Psychology and familiar with attachment theory were extensively trained on 10 pilot videotapes until an inter-rater agreement of at least 80% was achieved. Then, the study videos were coded blindly to all information relating to the dyads (included group and pre–post status).

Maternal discipline

Maternal discipline was assessed, both at pre- and post-test, during a 2-minute clean-up task, where mothers were instructed to ask their child to put all the toys in a box.

To code the videos, the adapted version of the discipline rating scales employed by Verschueren, Dossche, Marcoen, Mahieu, and Bakermans-Kranenburg (2006) was used, in line with other studies applying the VIPP-SD (Pereira et al., 2014; Yagmur et al., 2014). Specifically, parental ability to use positive strategies (e.g. distraction) in order to prevent conflict escalation was rated on the Inflexibility scale, ranging from 1 (Flexible) to 5 (Inflexible). The tendency of parent to adopt “giving up” behaviors was rated on the Laxness scale, ranging from 1 (No laxness) to 5 (Continuous laxness), whereas non-harsh physical attempts to get the child to clean up was rated on the Physical interference scale, ranging from 1 (No physical interference) to 5 (Continuous physical interference). The other discipline observation scales (i.e. Psychological Control, Verbal Overreactivity/Negativity, and Harsh Physical Interference) were not employed in the current study because of the extremely low frequencies of these behaviors in our sample. Additionally, parental positive regard and emotional support to the child was rated on the Erickson Supporting Presence scale (Egeland, Erickson, Clemenhagen-Moon, Hiester, & Korfmacher, 1990), ranging from 1 (Completely fails to be supportive) to 7 (Skillfully provides support throughout the session).

Videos were coded by 1 coder (different from those assessing maternal sensitivity) with a Master’s degree in Psychology who was blind to all data relating to the dyads (included group and pre–post status). Another coder rated 5 out of 12 cases. Inter-rater reliability ranged from .54 (for Supportive Presence scale at pretest, due to a score discrepancy of 1.50 for one participant) to 1.00 (for Physical Interference scale at post-test), with a mean value of .82.

Mother–intervener alliance

The mother–intervener alliance was assessed through semi-structured logbooks filled out by the intervener after each visit. In line with Stolk et al. (2008), the following questions were employed: (1) “How pleasant was the contact with the mother?” (2) “Can this mother be influenced?” (3) “Did the mother show a cooperative attitude during the intervention?” (4) “Did the mother show an open attitude during the intervention?”. Pleasantness, Influenceability, Cooperative Attitude, and Open Attitude were rated on a 5-point scale, ranging from 1 (negative) to 5 (positive). The mean score obtained for each question during the first five home visits was computed (Stolk et al., 2008).

Results

Preliminary analyses conducted by separate Mann–Whitney test revealed no differences between the intervention and control group in relation to maternal Sensitivity (U = 15.0; p = .76), Inflexibility (U = 12.5; p = .43), Laxness (U = 13.0; p = .53), Physical Interference (U = 10.5; p = .27) and Supportive Presence (U = 11; p = .34) at pretest.

In Table 1, means and SDs for all outcome variables are reported.

Table 1.

Descriptive statistics for all outcome variables.

Measures	Pretest				Post-test
	Experimental		Control		Experimental		Control
	M (SD)	Min.–max.	M (SD)	Min.–max.	M (SD)	Min.–max.	M (SD)	Min.–max.
Sensitivity	.47 (.13)	.22–.63	.40 (.23)	.21–.73	.55 (.20)	.27–.74	.46 (.19)	.16–.67
Inflexibility	2.71 (1.11)	1–4	3.20 (1.30)	1–4	1.93 (.73)	1–3	2.60 (1.14)	1–4
Laxness	3.86 (1.21)	2–5	3.20 (1.48)	1–5	2.71 (.76)	2–4	2.60 (.89)	1–3
Physical interference	1.71 (1.11)	1–4	2.40 (1.14)	1–4	1.43 (.79)	1–3	1.40 (.89)	1–3
Supportive presence	5.36 (1.25)	4–7	4.60 (0.55)	4–5	5.14 (.85)	3.5–6	5.00 (1.00)	4–6

SD: standard deviation.

To assess intervention effects on maternal sensitivity and positive discipline, we conducted Wilcoxon tests for each outcome variable separately by group. In the experimental group, there were significant differences between pre- and post-test ranks on Inflexibility (Z = −2.12; p = .03) and Laxness (Z = −2.27; p = .02) scales, with a decline in ranks after the intervention. No significant differences related to maternal Sensitivity (Z = −1.35; p = .18), Physical Interference (Z = −1.00; p = .32) and Supportive Presence (Z = .00; p = 1.00) were found. In the control group, no significant differences between pre- and post-test ranks on either sensitivity or the four discipline scales emerged, although the ranks on the Physical Interference scale tended to be lower at the post-test in comparison with the pretest (Z = −1.89; p = .06).

Table 2 presents mean and SDs for the mother–intervener alliance (i.e. Pleasantness, Influenceability, Cooperative Attitude, and Open Attitude) scales.

Table 2.

Descriptive statistics related to the alliance scales.

Alliance scales	Mean	SD	Min.–max.
Pleasantness	4.57	.35	4.00–5.00
Influenceability	3.69	.29	3.25–4.00
Cooperative attitude	4.22	.48	3.50–4.80
Open attitude	4.03	.54	3.00–4.75

SD: standard deviation.

We found no significant correlations between alliance scale mean scores and pre–post difference scores for maternal outcome variables.

Discussion

Our pilot study is the first test of the efficacy of the attachment-based VIPP-SD intervention in improving maternal sensitivity and positive discipline in a maltreatment risk sample. We found that the intervention was effective in reducing dysfunctional strategies of maternal discipline, namely, inflexibility and laxness, thus showing promising evidence of the usefulness of the VIPP-SD with mothers who had been placed in residential care centers due to a court guardianship order. Despite the exploratory nature of this pilot study, our results provide the first evidence of the feasibility of the VIPP-SD in residential care, thus widening the application of this intervention to a very challenging context.

Mothers who attended the intervention increased their ability to prevent conflict escalation by correctly assessing the situation and by using positive discipline strategies (i.e. changing to a new strategy or approaching the child and the task in a positive manner). Moreover, they were better able to reduce permissive parenting when interacting with their child, for example, by giving clear commands and stating the rules in a convincing way when needed.

Conversely, mothers from the control group did not significantly change inflexibility and laxness behavioral strategies from pre- to post-test sessions, although a decline in scores on both dimensions was observed (which is likely to be due to the educational support provided by social workers within the residential care setting). Therefore, it is probable that specific characteristics of the VIPP-SD may account for its success in promoting important aspects of sensitive discipline behaviors in mothers at high risk of maltreatment. As argued by Pereira and colleagues (2014), who found intervention effects on reducing maternal harsh discipline in severely deprived families, we suggest that the distinctive aspects of the VIPP-SD play a crucial role in promoting change in high-risk contexts. These distinctive aspects include its focus on a collaborative rather than expert approach, reinforcing positive parent–child interactions, and providing concrete options and practice opportunities for sensitive behavior management skills in a familiar environment through the video feedback. Furthermore, our preliminary data on mother–intervener alliance show globally very high ratings in terms of pleasantness, cooperative attitude, and open attitude across the sessions. Although no alliance dimensions correlated with maternal outcomes and alliance scores reflect the interveners’ subjective judgments, the strong mother–intervener alliance we found is an important finding for future implementation. It shows that VIPP-SD can be successfully implemented with mothers placed in residential settings by creating a supportive relationship and a “holding environment” that allows mothers to feel at ease and helps them understand the importance of enhancing their parental skills in interacting with their children. Additionally, informal feedback from both mothers and social workers revealing satisfaction with the intervention (e.g. positive comments and feelings after VIPP sessions), jointly with the absence of drop-out in the intervention group, highlights the opportunity of integrating the VIPP-SD within the educational, social, and psychological programs offered to mothers in residential care.

However, it is also worth noting that we found no intervention effects on physical interference and supportive presence in the current pilot study. Moreover, in contrast with our hypothesis and findings from VIPP studies with larger samples (Cassibba, Castoro, Costantino, Sette, & van IJzendoorn, 2015; Kalinauskiene et al., 2009; Van Zeijl et al., 2006; Velderman et al., 2006; Yagmur et al., 2014), maternal sensitivity did not significantly improve after the intervention, although higher post-test scores than pretest scores suggested a trend toward improvement. There are different methodological reasons that might explain this null result. First of all, the small sample size undeniably restricted the power of statistical analyses to detect significant changes. Second, the instrument employed to assess maternal sensitivity (i.e. MBQS) might be not sufficiently specific to capture changes in maternal behaviors associated with the intervention. Finally, given the complex nature of maternal sensitivity, it may be that a longer time interval between the intervention and the post-test might be needed to detect improved maternal capacity to interpret and respond to the child’s signals. Support for this conjecture is that we measured maternal sensitivity only 2 weeks after the intervention took place, whereas studies that found a significant effect typically had a longer time lapse (e.g. Van Zeijl et al., 2006).

While the small sample size and a very short-term follow-up represent significant limitations of our pilot study, its strengths include a randomized control trial design, reliable observational measures of parenting and no treatment drop-outs. Our study suggests the feasibility of the VIPP-SD intervention with high-risk mothers to facilitate the adoption of positive discipline strategies in order to prevent child maltreatment. Although our intervention was brief, it was much more focused than the standard educational interventions carried out in Italian residential care centers.

Our preliminary findings indicate an effect of the VIPP-SD in reducing maternal dysfunctional discipline strategies, such as inflexibility and laxness. Consequently, our data highlight the potential impact of an approach focused on parent–child interaction in targeting maltreatment behaviors. Indeed, although several studies identified maltreatment as part of broader disturbances in parent–child relationship (e.g. Belsky, 1993), very few prevention programs systematically address this domain in high-risk families (Tarabulsy et al., 2008). Future studies are thus needed to evaluate how improvement in maternal sensitive discipline might result in a reduction of maltreating behaviors. Furthermore, to corroborate our preliminary results, future studies should test the effectiveness and feasibility of this brief preventive home-based intervention in a larger sample at risk of child maltreatment and with a longer follow-up period.

Footnotes

Acknowledgements

We are especially grateful to Femmie Juffer for her suggestions on the study design, Marian Bakermans-Kranenburg for her valuable comments on the draft of this manuscript, and Leslie Rescorla for her careful revision of English. We are thankful to Ilaria Negri, Enrita Pozzi, and Nadia Dottori for data coding. Finally, we would like to thank all the mothers who participated in the study with their children, as well as the social workers of the residential communities for mothers and children involved in this project.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Italian Health Ministry (Ricerca Corrente 2012–2014).

Author biographies

Marta Casonato is a PhD Researcher in Developmental Psychology, who collaborates with the University of Torino, the IRCCS Medea, and the ARAI-Regione Piemonte. Her research interests focus on parenting, especially in the field of adoption, as well as on the developmental trajectories of children who experienced abuse and neglect.

Sarah Nazzari is a PhD student in the Research Department of Clinical, Educational and Health Psychology at the University College London and a consultant at IRCCS Medea, Italy. She is interested in stress-related mechanisms involved in risk for psychopathology as well as in the role of early experiences in determining children’s developmental trajectories.

Alessandra Frigerio is a PhD Researcher in Child Psychopathology Unit at IRCCS Medea, Italy. Her research interests focus on the mechanisms involved in risk for psychopathology, with special attention on the interplay between social and biological factors in children’s development, as well as on evidence-based parenting interventions designed to promote positive parent-child relationships.

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