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Topic Editor: Marinus van IJzendoorn, PhD, Leiden University, Netherlands
To improve long-term developmental outcomes of infants and children, prevention and intervention programs should focus on promoting secure parent-infant attachment. Attachment-based interventions often target specific issues, such as parental sensitivity, behaviours and state of mind. However, exclusive focus on behavioural training for parent sensitivity rather than a focus on sensitivity plus support, or a focus on sensitivity plus support plus internal representations (e.g., individual therapy), the use of video feedback and brief (5- to 16-session) interventions focusing on parental sensitivity seem the most effective in improving attachment security, and also have yielded positive results with adoptive parents. In addition, the intervention site (home versus office) and the presence of multiple risk factors did not affect efficacy, but interventions conducted with clinically referred patients/clients and those that included fathers were more effective than interventions without such characteristics.
A few sensitivity-focused interventions have had some impact on disorganized attachment as well. However, it is believed that interventions focusing on atypical parental behaviours (e.g., failing to keep a child safe, failing to comfort a distressed child, laughing while the child is distressed, asking for affection and reassurance from the child, or threatening to harm) are most likely to reduce disorganized attachment. To date, attachment-based interventions have focused primarily on precursors of insecure attachment, rather than disorganized attachment. Future studies should therefore evaluate interventions for their potential to prevent disorganized attachment.
Currently, the research evidence for enhancing the attachment relationship favours brief, highly targeted interventions, once the child is at least six months old. However, more comprehensive, long-term interventions or other types of interventions may be necessary for some high-risk families. A number of important issues still need to be studied before definitive conclusions can be reached on how to best promote secure attachment in different types of families. These include the durability of the effects of the interventions, the mechanisms contributing to their efficacy, and their effectiveness in real-world arenas (as opposed to clinical trials) with different types of families.
Nonetheless, it is clear that service providers should be trained in the use of attachment-based techniques that have proven to be effective. Attachment-based intervention programs should be incorporated into existing home visitation and parent education programs, while policies should identify means by which families can access consistent parenting and psychological support throughout their child’s life. Economic analyses now clearly indicate the cost-effectiveness, both in dollars and in human suffering, of providing services to families with infants, before psychopathology develops.
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