Evidenced Based Practices for insecurely attached children and trauma

February 20, 2013

I am frequently asked about “attachment therapy” and “attachment parenting” and various treatments. Many books and others claim success with their approach and individuals often write glorious reviews of these approaches. Yet, we know that these approaches are NOT supported in the literature and withstanding the scrutiny of peers. As such, I wanted to just briefly compile a short list of assessments, tools, treatments and theory approved by Advocates for Children in Therapy that is evidenced based (researched and replicated with a control group) and a list of unsupported assessments, tools, treatments and theory. These can also be found on the Advocates for Children in Therapy website as well as literature such as Handbook of Attachment, Disorganized Attachment, Disorganized Attachment and Caregiving, Parenting Representations, Clinical Applications of the Adult Attachment Interview and others. I have also included a list of accepted assessment tools for assessing attachment quality.


Parent-Child Interaction Therapy (PCIT)

Kazdin Method for Parenting the Defiant Child

Attachment and Biobehavioral Catch-up Intervention

Circle of Security

Incredible Years

Adult Attachment Interview

Strange Situation

Attachment Q-Sort 

Attachment Story Telling Completion Task

Attachment Doll Play Assessment

Adult Attachment Projective Picture System

Caregiving Helplessness Questionnaire

Working Model of Child Interview

Parent Development Interview

Circle of Security Interview

Attachment Script Sets

Ainsworth Maternal Sensitivity Scales


Below is a list of treatments and interventions, tools and theories  NOT recommended:

  • Attachment Disorder
  • Attachment Therapy
  • Attachment Therapy Parenting
  • Beyond Consequences
  • Cline/Helding Adopted and Foster Child Assessment
  • Cline/Helding Adoptive Parent Attitude Assessment
  • Complex Trauma
  • Corrective Attachment Therapy
  • Critical Care Parenting
  • Dr Post’s New Family Revolution
  • Dyadic Developmental Psychotherapy
  • Emotional Deficit Syndrome
  • Family Centered Regulatory Therapy
  • Holding Therapy
  • Holding Time
  • Humanistic Attachment Therapy
  • Integrative Dyadic Psychotherapy
  • Nancy Thomas Parenting
  • Family Attachment Narrative
  • Pre and Peri Natal Psychology
  • Rage Therapy
  • Rage Reduction Therapy
  • Randolph Attachment Disorder Questionnaire
  • Reactive Attachment Disorder
  • Stress Model
  • Theraplay
  • Z-Therapy

On the Advocates for Children in Therapy Website, they list the names of proponents of the above treatments.  When entrusting your care and the care of your children to someone following one of these models, caution and care must be taken. While there may certainly be some benefits, there is a possibility of doing more harm than good. Remember, the motto of the creators of the Circle of Security state “Parenting in 25 words or less: ALWAYS be BIGGER, STRONGER, WISER, and KIND. Whenever possible, follow the child’s need. Whenever necessary, take charge.” Ensuring proper  treatment for your child is a take charge moment!!!

Predicting Harsh Parenting In Toddlerhood and Beyond….

April 1, 2012

Observation and research data shows that level of parent sensitivity during the first year of life can predict harsh parenting during toddlerhood.  These early predictors , while not in and of themselves the cause, put children at risk later in toddlerhood and school age for behavioral and emotional problems in both the home and school setting. These caregiving patterns, without intervention, have been shown to remain constant and stable through the child’s development into later childhood years.

Attuned sensitive caregiving involves a three task process for caregivers: 1) perceiving a child’s cue 2) interpreting the child’s cue accurately 3) responding to the child’s cues promptly and appropriately. Many internal (what is going on in the caregivers head and heart; depression; anxiety) and external factors (marriage distress; social support network; if a daycare, number of other children) are involved regarding how well a caregiver accomplishes the tasks of providing sensitive and responsive care-giving.

Harsh caregiving may include subtle and blatant acts, either verbal and/or physical ranging from ill timed tone of voice (caregiver is irritated) through physical aggression (slapping or worse).

Parents at risk for harsh and/or abusive parenting may display a challenge in one or more of the above three areas. Milner (1993, 2003) describes four stages involved in parenting strategies that  put children at risk for physical abuse.

Parents at risk for abusive behavior to children often display the following (Milner; 1993, 2003):

1) Less attentive and attuned to their children’s behavior when compared to average, non-abusive and low risk parents

2) Interpretations of the child’s behavior are often negative, including hostile intent (they are doing this to me) and generalized (they always do this; it is how they are wired)

3) Exclusion of the context of behaviors (bad day at school, sad because their friend was hurtful, it is late and the child is tired, etc).

4) Rigidity to parenting strategies and lack insight into how well their strategies are working and the emotional/physical impact of said strategies

Furthermore, other studies  have shown a lack of respect for the child economy and “physical” interference with the child’s behavior, especially during periods of exploration, are also a characteristic of some parents who demonstrate harsh/abusive parenting as a pattern.

The suggested intrusive as well as harsh/abusive parenting as a pattern seem to share a lack of empathy or understanding for the child behavior and motives in both average, daily interactions and discipline moments (Joosen, Mesman, Bakermans-Kranenburg & van Ijzendoorn, 2012).

Caregivers may be misattuned to their own thoughts and dialogues and may or may not be aware of these strategies, often using justifications for their own behavior. This adaptation may often be as of a result of their own history of being cared for, current environmental or relational conditions, and/or their own mental health issues.

For example; in a custody situation, the caregivers may be already stressed and while their has been no historical evidence of harsh caregiving, the threat of the marriage ending may produce enough stress that a parent becomes less attuned and sensitive to their child. They may read the child’s cues properly, but may attribute this cue to something that the other parent (acussed) has done to the infant/child. While the parent may respond appropriately to the child, the attribution of the child’s cue may inadvertently cause the the parent reading the cue to begin to act subtly hostile towards the other parent. Over time, this may become a full blown need to “protect” the child from the other parent and over the years resulted in intrusive caregiving to the child – questioning everything and acting very anxious – which the child would pick up on and adapt accordingly.

Meanwhile, the “acussed parent” over time experiences the child withdrawing due to the anxiety and rather than address this miscue (has a need but is expressing it indirectly, not at all or the opposite of what they need), acts on it, becoming more harsh and resentful towards the child or withdrawing from the relationship with the child.

While sometimes harsh parenting is intergenerational, sometimes it brought on by the situation and environment, and sometimes it is both.

This is why in a custody or placement decision an important part in an assessment is to evaluate the attachment of the child to each caregiver and gain a deeper understanding into the complexity of these dynamics, how to arrange a placement schedule that is beneficial to the child, and help the parents be the best versions of themselves they are meant to be. Parenting is forever – in the eyes of a child. Contact us for more information at 608-785-7000×221 or email info@effectivebehavior.com

Attachment and Custody: The King Solomon Dilemma

February 7, 2012

Written by our Consulting Psychologist – Kip Zirkel, PhD.

The whole area of infant/toddler placement continues to be one of the most difficult issues facing Guardians ad litem, Family Court Commissioners and custody evaluators, and to date there have been little in the way of social science research to give us any guidance. In fact, the two primary research teams who have focused on this issue have come to opposite conclusions, with Judith Solomon’s group suggesting that overnights for young children should be avoided* (see note below), and Kelly and Lamb on the other side suggesting that young children can do quite well with overnights.  The struggle to balance parent’s right to have an ongoing relationship with a child with the child’s need for developing a secure and predictable attachment is at the heart of the problem, and now we have several new studies which go a long way towards resolving these contradictory findings.


A recent series of ongoing research studies down in Australia (McIntosh and friends), along with a similar report coming out of the University of Oxford, have begun to shed some light on this issue. And we are also fortunate to have the entirety of the most recent issue of the Family Court Review (July 2011) devoted to infant/toddler attachment and the question of custody and access plans. Interestingly, these articles are coming out at right about the same time as the “50/50” initiative (commonly referred to as the “father’s rights” campaign) is gathering steam around the country. It appears that the issues raised in the research studies mentioned above will generate quite a bit of discussion and argument.


Perhaps to oversimplify a bit, on one side of the table are the “shared placement” proponents, who claim that children need the advantage of a shared placement plan with two involved parents (often interpreted as parents sharing an exact “50/50” division of parenting time) and that states should have  statutes supporting this presumption.  Father’s rights groups traditionally have argued for this approach, citing a supporting body of research to support their legislative initiatives.


On the other side of the table are the “primary residence” proponents, who argue (and also cite research) that babies and toddlers need the safety and security of a primary residence, that there should be a primary caretaker (typically the mother in most cases) and that the non-residential parent should have frequent, ongoing contact. However, overnights should be postponed until the baby reaches a certain age (ranging from 2 until about 4). This argument also presupposes that the very earliest months of a baby’s life require the establishment of a secure attachment to one parent, and that if this process is disrupted, there will be serious emotional consequences down the road.


Upon reviewing the three recent research reports noted above, it is clear that those who argue that a baby or toddler should have one primary residence have the force of this research behind them. This should come as no surprise to most of us, since I along with many of you have agreed that one should not disturb the delicate attachment process by splitting the baby between two homes, but that the non-residential parent should be gradually “phased in” as the baby matures and develops the capacity to separate from his or her primary caregiver. I will summarize below the major points raised by these articles. Of course you are encouraged to read the original sources for yourselves, but if you don’t have the time or inclination, perhaps this summary will assist and inform you.

  1. First of all, gender doesn’t matter. Babies can attach to either gender, as long as that individual is present, available emotionally, sensitive to the child’s moods, “in tune” with the child, responsive, and is not absent for long periods of time.
  2. Every baby needs to form the security of at least one parent (or parent-figure) in order to ensure the attachment security grows. This early attachment should not be disrupted or compromised.
  3. The quantity of time the infant spends with a parent is not as important as the quality of that relationship (although of course there has to be a minimum period of contact for the quality of the relationship to flourish.
  4. Shared time works best for parents who cooperatively work it out without the intervention of courts. But then we don’t see these in the course of our legal practice.
  5. Shared time arrangements for children of any age pose particular risks if there is ongoing conflicts, or the mothers express ongoing safety concerns.
  6. Shared care carries special risks for children under the age or 4, even with cooperative parents.
  7. Parents who enter into shared care arrangements tend over time to drift back to “mother primary” care.
  8. There is no research establishing a clear link between shared time and better outcomes for children. Better outcomes for children arise from a host of other factors (i.e., the quality of care, relationship between parents, temperament of the child, absence of conflict, etc.).
  9. Care arrangements in infancy should support the growth and consolidation of the primary relationship, yet allow for the familiarity and growing attachment with the “second” parent.
  10. If the attachment process in the first two years of life is disrupted, it will affect the hard wiring of the child’s brain, with far reaching consequences later including the possibility that the child will not attach securely to other parent-figures.
  11. Overnight care is not essential to the formation of secure attachment in young children. Overnight care arrangements essentially are ordered to address the rights of the parent rather that the best interests of the child.
  12. Equal or near-equal distribution for giving time is not normative, even in intact families. It is not clear why a separation/divorce situation would require something different.
  13. Thorough assessment of the attachment quality between a child and his parents is an essential component, if not the most important component, of a custody evaluation.

These are the major points brought out in these recent research efforts. They may raise more questions than they answer. For one, how does one go about doing an assessment of the attachment between parents and children in a timely and efficient manner? What factors should be given more weight in doing assessments? Should we attempt to “improve” the attachment between a child and a parent rather than simply placing the child with the other, presumably healthier, parent?

I would encourage you to read through the most recent issue of the Family Court Review (July 2011), available through the AFCC organization.


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Contact us for further information on having an attachment assessment completed at info@effectivebehavior.com or click here to make a referral. 

* Clarification:  Dr. Carol George (personal communication, February 19, 2013) “Our position is similar to Jenn McIntosh’s position, which is under high conflict and poor parental communication, overnights are not a good idea.  If parents can negotiate these problems between adults, security can be obtained.”

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