Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-25T17:49:21.066Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of interventions in preventing disorganized attachment: A meta-analysis

Published online by Cambridge University Press:  11 April 2017

Christopher R. Facompré ,
Kristin Bernard  and
Theodore E. A. Waters
Christopher R. Facompré*
Affiliation:
New York University–Abu Dhabi
Kristin Bernard
Affiliation:
Stony Brook University
Theodore E. A. Waters
Affiliation:
New York University–Abu Dhabi
*
Address correspondence and reprint requests to: Christopher R. Facompré, Department of Psychology, New York University–Abu Dhabi, P. O. Box 129188, Abu Dhabi, United Arab Emirates; E-mail: christopher.facompre@nyu.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Disorganized attachment is associated with a host of negative developmental outcomes, leading to a growing interest in preventative interventions targeting the attachment relationship in infancy. The objective of this meta-analysis was to assess the effectiveness of interventions that aimed to prevent or reduce rates of disorganization among children at risk. We performed a literature search using PsycINFO, MEDLINE, and ProQuest databases for studies published between January 1989 and August 2016. All 16 studies (N = 1,360) included a control condition and reported postintervention rates of organized and disorganized attachments assessed by the Strange Situation Procedure. Results showed that, overall, interventions were effective in increasing rates of organized attachment compared to control conditions (d = 0.35, 95% CI [0.10–0.61]). Moderator analyses demonstrated that interventions were more effective (a) in more recently published studies than in older studies, (b) for maltreated samples than nonmaltreated samples, and (c) as children increased in age. These results have important implications for future development, tailoring, and implementation of attachment-based intervention programs.

Type
Regular Articles
Information
Development and Psychopathology , Volume 30 , Issue 1 , February 2018 , pp. 1 - 11
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

The authors thank Anne Moyer and Marinus H. van IJzendoorn for their thoughtful comments on earlier drafts of this manuscript. We also acknowledge Marian J. Bakermans-Kranenburg, Marinus H. van IJzendoorn, and Femmie Juffer for their meta-analytic review in 2005, which inspired this project.

References

Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (2015). Patterns of attachment: A psychological study of the Strange Situation. New York: Psychology Press. (Original work published 1978)Google Scholar
*Bakermans-Kranenburg, M. J., Juffer, F., & van IJzendoorn, M. H. (1998). Interventions with video feedback and attachment discussions: Does type of maternal insecurity make a difference? Infant Mental Health Journal, 19, 202–219.3.0.CO;2-P>CrossRefGoogle Scholar
Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., & Juffer, F. (2003). Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin, 129, 195–215. doi:10.1037/0033-2909.129.2.195 Google Scholar
Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., & Juffer, F. (2005). Disorganized infant attachment and preventive interventions: A review and meta-analysis. Infant Mental Health Journal, 26, 191–216. doi:10.1002/imhj.20046 CrossRefGoogle Scholar
Belsky, J. (1997). Variation in susceptibility to rearing influence: An evolutionary argument. Psychological Inquiry, 8, 182–186. doi:10.1207/s15327965pli0803 CrossRefGoogle Scholar
Belsky, J. (2005). Differential susceptibility to rearing influence: An evolutionary hypothesis and some evidence. In Ellis, B. & Bjorklund, D. (Eds.), Origins of the social mind: Evolutionary psychology and child development (pp. 139–163). New York: Guilford Press.Google Scholar
Belsky, J., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2007). For better and for worse differential susceptibility to environmental influences. Current Directions in Psychological Science, 16, 300–304. doi:10.1111/j.1467-8721.2007.00525.x Google Scholar
Benoit, D. (2004). Infant-parent attachment: Definition, types, antecedents, measurement and outcome. Paediatrics & Child Health, 9, 541.CrossRefGoogle ScholarPubMed
Berlin, L. J., Cassidy, J., & Appleyard, K. (2008). The influence of early attachments on other relationships. In Shaver, J. C. P. R. (Ed.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 333–347). New York: Guilford Press.Google Scholar
Bernard, K., & Dozier, M. (2010). Examining infants’ cortisol responses to laboratory tasks among children varying in attachment disorganization: Stress reactivity or return to baseline? Developmental Psychology, 46, 1771–1778. doi:10.1037/a0020660 Google Scholar
*Bernard, K., Dozier, M., Bick, J., Lewis-Morrarty, E., Lindhiem, O., & Carlson, E. (2012). Enhancing attachment organization among maltreated children: Results of a randomized clinical trial. Child Development, 83, 623–636. doi:10.1111/j.1467-8624.2011.01712.x Google Scholar
Borenstein, M. (2009). Effect sizes for continuous data. In Cooper, H., Hedges, L. V., & Valentine, J. C. (Eds.), The handbook of research synthesis and meta-analysis (2nd ed., pp. 221–235). New York: Sage.Google Scholar
Borenstein, M., Hedges, L. V., Higgins, J., & Rothstein, H. R. (2009). Multiple outcomes or time-points within a study. In Bornstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (Eds.), Introduction to meta-analysis (pp. 225–238). Hoboken, NJ: Wiley.Google Scholar
Bowlby, J. (1969). Attachment and Loss: Vol. 1. Attachment. New York: Basic Books.Google Scholar
Bowlby, J. (1980). Attachment and Loss: Vol. 3. Loss. New York: Basic Books.Google Scholar
Carlson, E. A. (1998). A prospective longitudinal study of attachment disorganization/disorientation. Child Development, 69, 1107–1128. doi:10.2307/1132365 CrossRefGoogle ScholarPubMed
Carlson, E. A., Egeland, B., & Sroufe, L. A. (2009). A prospective investigation of the development of borderline personality symptoms. Development and Psychopathology, 21, 1311–1334.Google Scholar
*Cassidy, J., Woodhouse, S. S., Sherman, L. J., Stupica, B., & Lejuez, C. W. (2011). Enhancing infant attachment security: An examination of treatment efficacy and differential susceptibility. Development and Psychopathology, 23, 131–148. doi:10.1017/S0954579410000696 Google Scholar
Cassidy, J., Ziv, Y., Stupica, B., Sherman, L. J., Butler, H., Karfgin, A., & Powell, B. (2010). Enhancing attachment security in the infants of women in a jail-diversion program. Attachment & Human Development, 12, 333–353. doi:10.1080/14616730903416955 CrossRefGoogle Scholar
*Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2006). Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology, 18, 623–649. doi:10.1017/S0954579406060329 Google Scholar
Cohen, N. J., Muir, E., Parker, C. J., Brown, M., Lojkasek, M., Muir, R., & Barwick, M. (1999). Watch, wait and wonder: Testing the effectiveness of a new approach to mother-infant psychotherapy. Infant Mental Health Journal, 20, 429–451.Google Scholar
*Cooper, P. J., & Murray, L. (1997). The impact of psychological treatments of postpartum depression on maternal mood and infant development. In Murray, L. & Cooper, P. J. (Eds.), Postpartum depression and child development (pp. 201–220). New York: Guilford Press.Google Scholar
Crittenden, P. (1995). The Preschool Assessment of Attachment. PAA. Unpublished manuscript.Google Scholar
Cyr, C., Euser, E. M., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2010). Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses. Development and Psychopathology, 22, 87–108. doi:10.1017/S0954579409990289 Google Scholar
DerSimonian, R., & Kacker, R. (2007). Random-effects model for meta-analysis of clinical trials: An update. Contemporary Clinical Trials, 28, 105–114. doi:10.1016/j.cct.2006.04.004 CrossRefGoogle ScholarPubMed
DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7, 177–188. doi:10.1016/0197-2456(86)90046-2 Google Scholar
De Wolff, M. S., & van IJzendoorn, M. H. (1997). Sensitivity and attachment: A meta-analysis on parental antecedents of infant attachment. Child Development, 68, 571–591.Google Scholar
Dozier, M., & Infant–Caregiver Project Lab. (2012). Attachment and biobehavioral catch-up. Unpublished manuscript, University of Delaware, Newark.Google Scholar
Duval, S. J., & Tweedie, R. L. (2000a). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463.CrossRefGoogle ScholarPubMed
Duval, S. J., & Tweedie, R. L. (2000b). A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association, 95, 89–98.Google Scholar
*Egeland, B., & Erickson, M. (1993). Implications of attachment theory for prevention and intervention. In Parens, H. & Kramer, S. (Eds.), Prevention in mental health (pp. 23–50). Lanham, MD: Aronson.Google Scholar
Egger, M., Davey Smith, G., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal, 315, 629–634.CrossRefGoogle ScholarPubMed
Euser, S., Alink, L. R., Stoltenborgh, M., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2015). A gloomy picture: A meta-analysis of randomized controlled trials reveals disappointing effectiveness of programs aiming at preventing child maltreatment. BMC Public Health, 15, 1068.Google Scholar
Fearon, R. P., Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., Lapsley, A.-M., & Roisman, G. I. (2010). The significance of insecure attachment and disorganization in the development of children's externalizing behavior: A meta-analytic study. Child Development, 81, 435–456. doi:10.1111/j.1467-8624.2009.01405.x Google Scholar
Fish, M. (2001). Attachment in low-SES rural Appalachian infants: Contextual, infant, and maternal interaction risk and protective factors. Infant Mental Health Journal, 22, 641–664. doi:10.1002/imhj.1024 CrossRefGoogle Scholar
*Gelfand, D. M., Teti, D. M., Seiner, S. A., & Jameson, P. B. (1996). Helping mothers fight depression: Evaluation of a home-based intervention program for depressed mothers and their infants. Journal of Clinical Child Psychology, 25, 406–422. doi:10.1207/s15374424jccp2504_6 Google Scholar
Groh, A. M., Roisman, G. I., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., & Fearon, R. (2012). The significance of insecure and disorganized attachment for children's internalizing symptoms: A meta-analytic study. Child Development, 83, 591–610.Google Scholar
*Heinicke, C. M., Fineman, N. R., Ruth, G., Recchia, S. L., Guthrie, D., & Rodning, C. (1999). Relationship-based intervention with at-risk mothers: Outcome in the first year of life. Infant Mental Health Journal, 20, 349–374.Google Scholar
Hertsgaard, L., Gunnar, M., Erickson, M. F., & Nachmias, M. (1995). Adrenocortical responses to the Strange Situation in infants with disorganized/disoriented attachment relationships. Child Development, 66, 1100–1106. doi:10.2307/1131801 Google Scholar
Hesse, E., & Main, M. (2006). Frightened, threatening, and dissociative parental behavior in low-risk samples: Description, discussion, and interpretations. Development and Psychopathology, 18, 309–343. doi:10.1017/S0954579406060172 CrossRefGoogle ScholarPubMed
Higgins, J., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21, 1539–1558. doi:10.1002/sim.1186 Google Scholar
Hoffman, K. T., Marvin, R. S., Cooper, G., & Powell, B. (2006). Changing toddlers’ and preschoolers’ attachment classifications: The circle of security intervention. Journal of Consulting and Clinical Psychology, 74, 1017–1026. doi:10.1037/0022-006X.74.6.1017 Google Scholar
*Juffer, F., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2005). The importance of parenting in the development of disorganized attachment: Evidence from a preventive intervention study in adoptive families. Journal of Child Psychology and Psychiatry, 46, 263–274. doi:10.1111/j.1469-7610.2004.00353.x Google Scholar
Lyons-Ruth, K. (1996). Attachment relationships among children with aggressive behavior problems: The role of disorganized early attachment patterns. Journal of Consulting and Clinical Psychology, 64, 64–73. doi:10.1037/0022-006X.64.1.64 Google Scholar
Lyons-Ruth, K., Bronfman, E., & Parsons, E. (1999). Maternal frightened, frightening, or atypical behavior and disorganized infant attachment patterns. Monographs of the Society for Research in Child Development, 64(3, Serial No. 258), 67–96. doi:10.1111/1540-5834.00034 Google Scholar
*Lyons-Ruth, K., Connell, D. B., Grunebaum, H. U., & Botein, S. (1990). Infants at social risk: Maternal depression and family support services as mediators of infant development and security of attachment. Child Development, 61, 85–98. doi:10.2307/1131049 Google Scholar
Lyons-Ruth, K., & Jacobvitz, D. (2008). Attachment disorganization: Genetic factors, parenting contexts, and developmental transformation from infancy to adulthood. In Cassidy, J. & Shaver, P. R. (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 666–697). New York: Guilford Press.Google Scholar
Main, M., & Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In Greenberg, M. T., Cicchetti, D., & Cummings, E. M. (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161–182). Chicago: University of Chicago Press.Google Scholar
Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. In Greenberg, M. T., Cicchetti, D., & Cummings, E. M. (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 121–160). Chicago: University of Chicago Press.Google Scholar
Melnick, S., Finger, B., Hans, S., Patrick, M., & Lyons-Ruth, K. (2008). Hostile-helpless states of mind in the AAI: A proposed additional AAI category with implications for identifying disorganized infant attachment in high-risk samples. In Steele, H. & Steele, M. (Eds.), Clinical applications of the Adult Attachment Interview (pp. 399–423). New York: Guilford Press.Google Scholar
*Moran, G., Pederson, D. R., & Krupka, A. (2005). Maternal unresolved attachment status impedes the effectiveness of interventions with adolescent mothers. Infant Mental Health Journal, 26, 231–249. doi:10.1002/imhj.20045 Google Scholar
*Moss, E., Dubois-Comtois, K., Cyr, C., Tarabulsy, G. M., St.-Laurent, D., & Bernier, A. (2011). Efficacy of a home-visiting intervention aimed at improving maternal sensitivity, child attachment, and behavioral outcomes for maltreated children: A randomized control trial. Development and Psychopathology, 23, 195–210. doi:10.1017/S0954579410000738 CrossRefGoogle ScholarPubMed
R Development Core Team. (2015). R: A language and environment for statistical computing [Computer software]. Vienna: R Foundation for Statistical Computing. Retrieved from http://www.R-project.org Google Scholar
Rosenthal, R. (1979). The file drawer problem and tolerance for null results. Psychological Bulletin, 86, 638–641. doi:10.1037/0033-2909.86.3.638 Google Scholar
*Sadler, L. S., Slade, A., Close, N., Webb, D. L., Simpson, T., Fennie, K., & 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, 391–405. doi:10.1002/imhj.21406 Google Scholar
*Sajaniemi, N., Mäkelä, J., Saolkorpi, T., von Wendt, L., Hämäläinen, T., & Hakamies-Blomqvist, L. (2001). Cognitive performance and attachment patterns at four years of age in extremely low birth weight infants after early intervention. European Child & Adolescent Psychiatry, 10, 122–129. doi:10.1007/s007870170035 Google Scholar
Schmidt, F. L., Oh, I. S., & Hayes, T. L. (2009). Fixed- versus random-effects models in meta-analysis: Model properties and an empirical comparison of differences in results. British Journal of Mathematical and Statistical Psychology, 62, 97–128.Google Scholar
Schuengel, C., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (1999). Frightening maternal behavior linking unresolved loss and disorganized infant attachment. Journal of Consulting and Clinical Psychology, 67, 54–63. doi:10.1037/0022-006X.67.1.54 Google Scholar
Schuengel, C., Bakermans-Kranenburg, M., van IJzendoorn, M. H., & Blom, M. (1999). Unresolved loss and infant disorganization: Links to frightening maternal behavior. In Solomon, J. & George, C. (Eds.), Attachment disorganization (pp. 71–94). New York: Guilford Press.Google Scholar
Sroufe, L. A., & Waters, E. (1977). Attachment as an organizational construct. Child Development, 48, 1184–1199. doi:10.2307/1128475 Google Scholar
Thompson, S. G., & Higgins, J. (2002). How should meta-regression analyses be undertaken and interpreted? Statistics in Medicine, 21, 1559–1573.Google Scholar
*Toth, S. L., Rogosch, F. A., Manly, J. T., & Cicchetti, D. (2006). The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: A randomized preventive trial. Journal of Consulting and Clinical Psychology, 74, 1006–1016. doi:10.1037/0022-006X.74.6.1006 CrossRefGoogle Scholar
*van den Boom, D. C. (1994). The influence of temperament and mothering on attachment and exploration: An experimental manipulation of sensitive responsiveness among lower-class mothers with irritable infants. Child Development, 65, 1457–1477.Google Scholar
van IJzendoorn, M. H., Schuengel, C., & Bakermans-Kranenburg, M. J. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11, 225–249. doi:10.1017/S0954579499002035 Google Scholar
Viechtbauer, W. (2010). Metafor: Meta-analysis package for R. R package version, 2010, 1-0 [Computer software]. Retrieved from http://www.metaforproject.org Google Scholar
Viechtbauer, W., López-López, J. A., Sánchez-Meca, J., & Marín-Martínez, F. (2015). A comparison of procedures to test for moderators in mixed-effects meta-regression models. Psychological Methods, 20, 360–374. doi:10.1037/met000002310.1037/met0000023.supp Google Scholar