A Scoping Review of Attachment-based Interventions for Children Ages 0-5 Years with Adverse Childhood Experiences Restricted; Files Only

Abstract

Adverse Childhood Experiences (ACEs) have significant negative effects on mental health. In addition, ACEs are associated with insecure attachment, which is regarded as a risk factor of later psychopathology. Understanding attachment-based interventions to address insecure attachment may provide a foundation for mitigating the negative impact of ACEs. This scoping review sought to capture an overview of attachment-based interventions for children with ACEs, and focused on types of ACEs, intervention components, and outcomes. Three databases, PubMed, PsycINFO, and Web of Science, were searched, and search terms included a combination of terms related to ACEs, attachment-based, intervention, child/family, and randomized controlled trial. A total of 1040 articles were screened against the inclusion criteria, and 22 articles were included in the review. Types of ACEs targeted in studies predominantly focused on child maltreatment and mental illness in households. Few studies targeted multiple ACEs, although ACEs often co-occur. In terms of caregivers, 17 out of 22 studies only included females. Intervention objectives focused on two themes: “Form a foundation of positive child-parent interactions” and “Promote positive child-parent interactions.” To achieve these objectives, intervention components and strategies included education, practice parenting skills, therapeutic relationship and analysis through observation and feedback and most interventions combined these strategies. Studies often assessed the outcomes of children’s attachment security; however, evidence on other outcomes was less often assessed, especially children’s mental health. In conclusion, further research is needed in the effectiveness of attachment-based interventions among children with a wider range of ACEs beyond child maltreatment and mental illness in households, in addition to children with multiple ACEs. Future studies should include more male caregivers and assess children’s mental health. This scoping review with a detailed investigation of interventions' components can provide a reference for designing future attachment-based interventions.

Table of Contents

1.     Introduction 1

2.     Review of Literature 7

2.1.    Overview of ACEs 7

2.2.    Health Outcomes of ACEs 10

2.3.    Attachment Theory 11

2.4.    ACEs and Attachment Security 14

2.5.    Insecure Attachment and Mental Disorders 17

2.6.    Interventions to Mitigate Negative Effects of ACEs 18

2.7.    GAP 20

3.     Methodology 21

3.1.    Information Sources 21

3.2.    Selection of Articles 22

3.3.    Eligibility Criteria 22

3.4.    Data Extraction 23

4.     Results 24

4.1.    Study Information 25

4.1.1.   Year of Publication  25

4.1.2.   Country 26

4.2.    Sample Description 27

4.2.1.   Sample Size 27

4.2.2.   Parents’ Age 27

4.2.3.   Parents’ Gender 28

4.2.4.   Parents Ethnicity 28

4.2.5.   Family Annual Income 29

4.2.6.   Children’s Age 30

4.2.7.   Children’s Gender 31

4.3.    ACEs details 31

4.3.1.   Types of ACEs 31

4.3.2.   Number of ACEs 35

4.4.    Study Design Details 36

4.4.1.   Length of Follow-up 36

4.4.2.   Measurements 37

4.5.    Intervention components 37

4.5.1.   Providers 37

4.5.2.   Frequency of Intervention Sessions 38

4.5.3.   Number of Sessions 38

4.5.4.   Length of Interventions 40

4.5.5.   Session duration 41

4.5.6.   Types of Delivery 41

4.6.    Intervention Objectives 42

4.6.1.   Theme 1: Form a Foundation for Positive Child-Parent Interaction 42

4.6.2.   Theme 2: Promote Positive Child-Parent Interaction 45

4.7.    Intervention Strategies 49

4.7.1.   Theme 1: Approach 49

4.7.2.   Theme 2: Core Strategies 50

4.7.3.   Theme 3: Tailor to Participants 54

4.7.4.   Theme 4: Implementation 56

4.8.    Outcomes 57

4.8.1.   Children’s Outcomes 57

4.8.2.   Child-Parent Interactions 61

4.8.3.   Parents’ Outcomes 63

5.     Discussion 69

5.1.    ACEs 69

5.2.    Intervention Objectives 71

5.2.1.   Form a Foundation for Positive Child-Parent Interactions 71

5.2.2.   Promote Positive Child-Parent Interactions 75

5.3.    Number of Sessions in Interventions 80

5.4.    Interventions Strategies 81

5.5.    Outcomes 82

5.6.    Other Key Findings 85

5.7.    Limitations 86

5.8.    Strengths 87

5.9.    Recommendations for Future Research 88

5.10. Conclusion  90

6.     References 92

7.     Appendices 111

7.1.    Appendix A 111

7.2.    Appendix B 114

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Mental Health Health Sciences, Human Development Health Sciences, Public Health
Palavra-chave	attachment-based intervention attachment trauma child Adverse Childhood Experiences mental health
Committee Chair / Thesis Advisor	McGee, Robin , Emory University Grabbe, Linda , Emory University Woods-Jaeger, Briana , Emory University

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