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!!!

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.

 

Click here to register now for our two hour CEU inservice at UW La Crosse. Webinars coming soon!

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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