A randomized trial of the Caregiver Interaction Profile (CIP) training with childcare providers: the Copenhagen Daycare Project study protocol.

BACKGROUND: Most young children (0-3 years) attend formal childcare in Denmark, many of them fulltime. Yet recent reports of the quality of Danish childcare centers have shown that in more than one-third of nurseries, the interactions between caregivers and young children (0-3 years) are of "insufficient" quality, which constitutes a risk for affected children's well-being and development. Effective interventions to improve childcare providers' interactive skills are necessary. METHODS: In this randomized controlled trial, we test the effectiveness of the Caregiver Interaction Profile training, which focuses on improving six core interactive skills: sensitive responsiveness, respecting children's autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions. We will recruit N = 200 childcare providers from nursery groups in Copenhagen (n = 100 training group, n = 100 waiting-list control group). Our primary outcomes are childcare providers' six interactive skills named above, observed from video-recorded interactions in the nursery groups. The secondary goal of our study is to test whether the training boosts children's social-emotional and linguistic development. To this end we aim to recruit N ≈ 500 children from participating childcare providers' nursery groups (n ≈ 250 training group, n ≈ 250 waiting-list control group). We measure social-emotional and linguistic development with various standardized questionnaires, filled out by parents and childcare providers. DISCUSSION: If the training is effective at improving childcare providers' interactive skills, then this will be an important foundation for implementation efforts, such as offering the training as part of the educational program of childcare providers. Future research should also evaluate whether the Caregiver Interaction Profile training is effective for childcare providers of older children (3-5 years) in Danish kindergartens. TRIAL REGISTRATION: This trial is registered at clinicaltrials.gov as "Testing the Effects of the Caregiver Interaction Profile Training on the Interactive Skills of Daycare Providers (CDP)" with registry ID NCT05654116. Registration date: 12/01/2022.

Six attachment discourses: convergence, divergence and relay.

Attachment concepts are used in diverging ways, which has caused confusion in communication among researchers, among practitioners, and between researchers and practitioners, and hinders their potential for collaboration. In this essay we explore how attachment concepts may vary in meaning across six different domains: popular discourses, developmental science, social psychological science, psychiatric diagnosis, psychotherapy, and child welfare practice. We attempt to typify these forms of attachment discourse by highlighting points of convergence, divergence, and relay between the different domains. Our general conclusions are that diversity in the use of attachment concepts across different domains of application has been largely unrecognised, and that recognition of these differences would reduce confusion, help identify sites where infrastructure needs to be developed to support coordination, and strengthen opportunities for collaboration to mutual benefit. We suggest that academic attachment discourse would benefit from clarification of core terminology, including: "attachment", "internal working model", "trauma", and "dysregulation".

Attachment histories and futures: reply to Vicedo's 'Putting attachment in its place'.

For Vicedo, 'putting attachment in its place' seems to entail two aspects. The first is working to understand the rise of attachment theory and its place within the history of knowledge practices. The second is to criticize the validity of attachment theory. In this reply, we appraise three criticisms made by Vicedo of attachment theory, chosen as points for sustaining a dialogue. Our main point in this reply is that, in excluding the work of attachment researchers after Ainsworth from consideration, Vicedo's work is not yet able to properly 'put attachment in its place', in either sense of the phrase. At most, she puts Bowlby in the 1950s-1960s in his place, but without speaking effectively to subsequent attachment research. In our view, not just the validity, but the very meaning of attachment as a scientific research programme cannot be understood outside of its temporal context, and the relationship this entails between theory and research, past and future.

Annual Research Review: Umbrella synthesis of meta-analyses on child maltreatment antecedents and interventions: differential susceptibility perspective on risk and resilience.

Child maltreatment in the family context is a prevalent and pervasive phenomenon in many modern societies. The global perpetration of child abuse and neglect stands in stark contrast to its almost universal condemnation as exemplified in the United Nation's Convention on the Rights of the Child. Much work has been devoted to the task of prevention, yet a grand synthesis of the literature is missing. Focusing on two core elements of prevention, that is, antecedents for maltreatment and the effectiveness of (preventative) interventions, we performed an umbrella review of meta-analyses published between January 1, 2014, and December 17, 2018. Meta-analyses were systematically collected, assessed, and integrated following a uniform approach to allow their comparison across domains. From this analysis of thousands of studies including almost 1.5 million participants, the following risk factors were derived: parental experience of maltreatment in his or her own childhood (d = .47), low socioeconomic status of the family (d = .34), dependent and aggressive parental personality (d = .45), intimate partner violence (d = .41), and higher baseline autonomic nervous system activity (d = .24). The effect size for autonomic stress reactivity was not significant (d = -.10). The umbrella review of interventions to prevent or reduce child maltreatment showed modest intervention effectiveness (d = .23 for interventions targeting child abuse potential or families with self-reported maltreatment and d = .27 for officially reported child maltreatment cases). Despite numerous studies on child maltreatment, some large gaps in our knowledge of antecedents exist. Neurobiological antecedents should receive more research investment. Differential susceptibility theory may shed more light on questions aimed at breaking the intergenerational transmission of maltreatment and on the modest (preventive) intervention effects. In combination with family-based interaction-focused interventions, large-scale socioeconomic experiments such as cash transfer trials and experiments with vouchers to move to a lower-poverty area might be tested to prevent or reduce child maltreatment. Prevalence, antecedents, and preventive interventions of prenatal maltreatment deserve continuing scientific, clinical, and policy attention.

Attachment and autism spectrum conditions: Exploring Mary Main's coding notes.

Distinguishing autism spectrum behaviors from behaviors relating to disorganized attachment can be challenging. There is, for instance, a notable overlap between both conditions in terms of behaviors deemed stereotypical. In addition, there are also similarities regarding some atypical social overtures. Responding to this overlap has been the subject for much debate in the literature. Disorganized attachment was first introduced and conceptualized by the attachment researcher, Mary Main. Main is considered the leading authority on coding this phenomenon. During the course of archival research, we obtained Main's notes on coding attachment in a group of 15 children with autism spectrum conditions (hereafter ASC). Drawing on these texts, this article explores Main's reasoning when making distinctions between ASC and attachment at the behavioral level. Our approach is informed by Chang's argument for the potential of "history as complementary science." Analysis indicates that, for Main, frequency and timing were important differential factors when attributing a behavior to either ASC or the child's attachment pattern.

The infant disorganised attachment classification: "Patterning within the disturbance of coherence".

Since its introduction by Main and Solomon in 1990, the infant disorganised attachment classification has functioned as a predictor of mental health in developmental psychology research. It has also been used by practitioners as an indicator of inadequate parenting and developmental risk, at times with greater confidence than research would support. Although attachment disorganisation takes many forms, it is generally understood to reflect a child's experience of being repeatedly alarmed by their parent's behaviour. In this paper we analyse how the infant disorganised attachment classification has been stabilised and interpreted, reporting results from archival study, ethnographic observations at four training institutes for coding disorganised attachment, interviews with researchers, certified coders and clinicians, and focus groups with child welfare practitioners. Our analysis points to the role of power/knowledge disjunctures in hindering communication between key groups: Main and Solomon and their readers; the oral culture of coders and the written culture of published papers; the research community and practitioners. We highlight how understandings of disorganised attachment have been magnetised by a simplified image of a child fearful of his or her own parent.

Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers.

Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that disorganized attachment (2) reliably indicates child maltreatment, (3) is a strong predictor of pathology, and (4) represents a fixed or static "trait" of the child, impervious to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the difference between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attachment theory for supportive work with families and for the development and evaluation of evidence-based caregiving interventions.

Attachment representations and autonomic regulation in maltreating and nonmaltreating mothers.

This study assessed attachment representation and attachment-related autonomic regulation in a sample of 38 maltreating and 35 nonmaltreating mothers. Mothers' state of mind regarding attachment was measured using the Adult Attachment Interview. They further watched an attachment-based comfort paradigm, during which we measured skin conductance and vagal tone. More maltreating mothers (42%) than nonmaltreating mothers (17%) had an unresolved/disoriented attachment classification. Attachment representation was related to physiology during the comfort paradigm: an unresolved state of mind and a nonautonomous classification were associated with a decrease in skin conductance during the comfort paradigm, specifically during the responsive caregiver scenario. However, physiology did not differ between maltreating and nonmaltreating mothers. The decrease in skin conductance of unresolved mothers during the comfort paradigm might be indicative of a deactivating response, which is congruent with the dissociative nature of the unresolved state of mind. The results point to the potential utility of interventions focused on attachment representations for maltreating mothers.

Baseline Functioning and Stress Reactivity in Maltreating Parents and At-Risk Adults: Review and Meta-Analyses of Autonomic Nervous System Studies.

We reviewed and meta-analyzed 10 studies ( N = 492) that examined the association between (risk for) child maltreatment perpetration and basal autonomic activity, and 10 studies ( N = 471) that examined the association between (risk for) child maltreatment and autonomic stress reactivity. We hypothesized that maltreating parents/at-risk adults would show higher basal levels of heart rate (HR) and skin conductance (SC) and lower levels of HR variability (HRV) and would show greater HR and SC stress reactivity, but blunted HRV reactivity. A narrative review showed that evidence from significance testing within and across studies was mixed. The first set of meta-analyses revealed that (risk for) child maltreatment was associated with higher HR baseline activity ( g = 0.24), a possible indication of allostatic load. The second set of meta-analyses yielded no differences in autonomic stress reactivity between maltreating/at-risk participants and nonmaltreating/low-risk comparison groups. Cumulative meta-analyses showed that positive effects for sympathetic stress reactivity as a risk factor for child maltreatment were found in a few early studies, whereas each subsequently aggregated study reduced the combined effect size to a null effect, an indication of the winner's curse. Most studies were underpowered. Future directions for research are suggested.

Traumatic Experience and Somatoform Dissociation Among Spirit Possession Practitioners in the Dominican Republic.

Recent studies in African contexts have revealed a strong association between spirit possession and severe trauma, with inclusion into a possession cult serving at times a therapeutic function. Research on spirit possession in the Dominican Republic has so far not included quantitative studies of trauma and dissociation. This study evaluated demographic variables, somatoform dissociative symptoms, and potentially traumatizing events in the Dominican Republic with a group of Vodou practitioners that either do or do not experience spirit possession. Inter-group comparisons revealed that in contrast to non-possessed participants (n = 38), those experiencing spirit possession (n = 47) reported greater somatoform dissociation, more problems with sleep, and previous exposure to mortal danger such as assaults, accidents, or diseases. The two groups did not differ significantly in other types of trauma. The best predictor variable for group classification was somatoform dissociation, although those items could also reflect the experience of followers during a possession episode. A factor analysis across variables resulted in three factors: having to take responsibility early on in life and taking on a professional spiritual role; traumatic events and pain; and distress/dissociation. In comparison with the non-possessed individuals, the possessed ones did not seem to overall have a remarkably more severe story of trauma and seemed to derive economic gains from possession practice.

Salivary α-Amylase Reactivity to Infant Crying in Maltreating Mothers.

Deviant physiological reactivity to infant stimuli has been suggested to underlie maladaptive parenting behavior. Our study involved 44 maltreating and 42 non-maltreating mothers. During a standardized cry paradigm, mothers listened to nine cry sounds of varying pitches. Saliva was collected at baseline, after each cry sound, and after a recovery episode. Salivary α-amylase (sAA) as a marker of autonomic nervous system (ANS) activity was assayed from saliva samples. Maltreating mothers showed lower overall sAA levels and an attenuated reactivity pattern to infant crying as compared to non-maltreating mothers. No effect of type of maltreatment (neglect only vs. neglect and abuse) was found. Furthermore, positive correlations between sAA and heart rate (HR) for non-maltreating mothers differed significantly from non-significant correlations between sAA and HR for maltreating mothers. This suggests anomalous asynchrony between different aspects of the ANS in maltreating mothers. Results indicate a lack of functional autonomic (re)activity as a contributing risk factor to child maltreatment.

Handgrip force of maltreating mothers in reaction to infant signals.

Handgrip force responses to infant signals were examined in a sample of 43 maltreating and 40 non-maltreating mothers. During a standardized handgrip paradigm, mothers were asked to squeeze a handgrip dynamometer at maximal and at half of their maximal handgrip strength while listening to infant crying and laughter sounds. Maltreating mothers used excessive force more often while listening to infant crying and laughter than non-maltreating mothers. Of the maltreating mothers, only neglectful mothers (n=20) tended to use excessive force more often during crying than non-maltreating mothers. Participants did not rate the sounds differently, indicating that maltreating mothers cannot be differentiated from non-maltreating mothers based on their perception of infant signals, but show different behavioral responses to the signals. Results imply that, in response to infant signals (i.e., crying or laughing), maltreating mothers may be insufficiently able to regulate the exertion of physical force.

Autonomic Reactivity to Infant Crying in Maltreating Mothers.

We examined autonomic reactivity to infant crying in a sample of 42 maltreating and 38 non-maltreating mothers. Exploratively, we tested if differential reactivity was related to child neglect versus the combination of neglect and abuse, and we tested whether mothers' experiences with maltreatment in their own childhood moderated the association between their current maltreatment status and physiology. During a standardized cry paradigm, mothers listened to cry sounds of various pitches. Heart rate (HR), pre-ejection period (PEP), skin conductance levels (SCLs), and vagal tone (root mean square of successive differences [RMSSD]) were measured as indicators of underlying sympathetic and parasympathetic reactivity. The maltreating mothers showed lower SCL reactivity to the cry sounds than non-maltreating mothers. Furthermore, significant negative correlations between HR and PEP in the non-maltreating group differed from nonsignificant correlations in the maltreating group, which suggests a lack of sympathetic cardiac control in maltreating mothers. We found no differences between neglectful mothers and those who were additionally abusive. Together, our findings support the notion of sympathetic hypoarousal as a risk factor for child maltreatment, which may be indicative of disengagement in a caregiving context. Intervention programs might focus on improving maternal sensitivity to improve responsiveness to child signals.