Protocol for a randomized controlled trial comparing the Circle of Security-parenting (COS-P) with treatment as usual in child mental health services

Aida Bikic, Johanne Smith-Nielsen, Søren Dalsgaard, James Swain, Peter Fonagy, James F Leckman, Aida Bikic, Johanne Smith-Nielsen, Søren Dalsgaard, James Swain, Peter Fonagy, James F Leckman

Abstract

Background: The quality of a child's attachment to its primary caregiver plays an important role for its long-term socioemotional development. While 'secure' attachment is associated with better outcomes, 'insecure' attachment is associated with a higher risk of externalizing and internalizing symptoms. Children referred to mental health services show much higher rates of insecure attachment than the general population, yet the parent-child relationship is rarely in treatment focus. Attachment quality is closely associated with parental sensitive responsiveness that is target of attachment-based interventions like Circle of Security (COS). COS has shown to improve attachment quality and the well-being of both children and parents. No randomized controlled trials have investigated the effect of COS on parental sensitivity and child psychiatric symptoms in child mental health services.

Objectives: To investigate whether COS-Parenting (COS-P) can increase observed maternal sensitivity and decrease children's psychiatric symptoms as an add on to treatment as usual (TAU).

Methods: In a randomized controlled parallel superiority trial COS-P is compared with TAU for parents of children referred to child mental health services (n = 186). Families are randomized 2:1 to intervention or control group, if their child is between 3 and 8 years old and scores ≥ 93d percentile on both the CBCL total score and the oppositional defiant disorder or conduct disorder subscale. Primary outcome is maternal sensitivity, secondary and exploratory outcomes include, among others, child psychiatric symptoms, parental stress and coping with children's negative emotions. Outcomes and adverse events are assessed before (T0) and after 10 weeks of treatment (T1) and 6 months later (T2). Regression analysis and /or ANOVA will be used for all outcomes.

Perspectives: Targeting the parent-child relation has the potential to reduce psychiatric symptoms in children. This trial will provide valuable information if attachment-based interventions like COS-P can enhance treatment as usual in child mental health services.

Trail registration: ClinicalTrials.gov Identifier: NCT03578016.

Conflict of interest statement

JSN is a Circle of Security-Parenting (COS-P) trainer and a certified COS-P fidelity coach. She provides COS-P trainings for professionals in Denmark with fees paid by Circle of Security International. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.

Figures

Fig 1. SPIRIT schedule of enrolment, interventions,…
Fig 1. SPIRIT schedule of enrolment, interventions, and assessments.
1)CBCL-Child Behavior Checklist; 2) K-SADS-Kiddie-Schedule for Affective Disorders and Schizophrenia- autism and schizophrenia part; 3) RIAS-Reynolds Intellectual Assessment Scales; 4) CIB-Coding interactive behavior; 5) BPI-Berkeley Puppet interview; 6) PRFQ-Parental Reflective Functioning Questionnaire (; 7) ECBI-Parent-rated Eyberg Child Behavior Inventory; 8) SDQ-Parent-rated Strengths and Difficulties Questionnaire; 9) PSS-Parental Stress Scale; 10) CCNES-Coping with Children’s Negative Emotions; 11) ADHD-RS—Attention Deficit Hyperactivity Disorder-Rating Scale; 12) MDI-Major Depression Inventory; 13) RAAS -Revised Adult Attachment Scale; 14) SAPAS-Standardized Assessment of Personality-Abbreviated Scale; 15) BSI-Brief Symptom Inventory.
Fig 2. CONSORT flow diagram.
Fig 2. CONSORT flow diagram.
Flowchart of the different phases of the COS-P trial.

References

    1. Waters E. and Cummings E.M. A secure base from which to explore close relationships. Child Dev, 2000. 71(1): p. 164–72. doi: 10.1111/1467-8624.00130
    1. Verhage M.L., et al.. Narrowing the transmission gap: A synthesis of three decades of research on intergenerational transmission of attachment. Psychol Bull, 2016. 142(4): p. 337–366. doi: 10.1037/bul0000038
    1. Ainsworth M.D.S., Blehar M.C., Waters E. & Wall S. Patterns of attachment. A psychological study of the Strange Situation.. 1978, N.J. Lawrence Erlbaum: Hillsdale.
    1. De Wolff M.S. and van Ijzendoorn M.H. Sensitivity and attachment: a meta-analysis on parental antecedents of infant attachment. Child Dev, 1997. 68(4): p. 571–91.
    1. Nievar M., & Becker B. Sensitivity as a privileged predictor of attachment: A second perspective on De Wolff and Van IJzendoorn’s meta-analysis. Social Development, 2008. 17: p. 102–114.
    1. Fearon R.P., et al.. The significance of insecure attachment and disorganization in the development of children’s externalizing behavior: a meta-analytic study. Child Dev, 2010. 81(2): p. 435–56. doi: 10.1111/j.1467-8624.2009.01405.x
    1. Groh A.M., et al.. The significance of insecure and disorganized attachment for children’s internalizing symptoms: a meta-analytic study. Child Dev, 2012. 83(2): p. 591–610. doi: 10.1111/j.1467-8624.2011.01711.x
    1. Groh A.M., Fearon R. P., Bakermans-Kranenburg M. J., Van IJzendoorn M. H., Steele R. D., & Roisman G. I. The significance of attachment security for children’s social competence with peers: A meta-analytic study. Attachment & human development, 2014. 16(2): p. 103–136. doi: 10.1080/14616734.2014.883636
    1. Sroufe L.A. Attachment and development: a prospective, longitudinal study from birth to adulthood. Attach Hum Dev, 2005. 7(4): p. 349–67. doi: 10.1080/14616730500365928
    1. Futh A., et al.. Attachment narratives and behavioral and emotional symptoms in an ethnically diverse, at-risk sample. J Am Acad Child Adolesc Psychiatry, 2008. 47(6): p. 709–718. doi: 10.1097/CHI.0b013e31816bff65
    1. Cowan P.A., et al.. Parents’ attachment histories and children’s externalizing and internalizing behaviors: exploring family systems models of linkage. J Consult Clin Psychol, 1996. 64(1): p. 53–63. doi: 10.1037//0022-006x.64.1.53
    1. Deater-Deckard K. and Petrill S.A. Parent-child dyadic mutuality and child behavior problems: an investigation of gene-environment processes. J Child Psychol Psychiatry, 2004. 45(6): p. 1171–9. doi: 10.1111/j.1469-7610.2004.00309.x
    1. Marchand J., Schedler S., Wagstaff D. A. The role of parents’ attachment orientations, depressive symptoms, and conflict behaviors in children’s externalizing and internalizing behavior problems. Early Childhood Research Quarterly 2004. 19(3): p. 449–462.
    1. Speltz M., Greenberg M. & DeKlyen M. Attachment in preschoolers with disruptive behaviour: a comparison of clinic-referred and non-problem children. Dev Psychopathol, 1990. 2: p. 31–46.
    1. Greenberg M.T., Speltz M. L., DeKlyen M., & Endriga M. C. Attachment security in pre-schoolers with and without extemalizing behavior problems: A replication.. Development and Psycho-pathology, 1991. 3: p. 413–430.
    1. Darling Rasmussen P., Storebø O. J., Shmueli-Goetz Y., Simonsen E., Bojesen A. B., & Bilenberg N. Attachment Representations in Mothers and Their Children Diagnosed with ADHD: Distribution, transmission and impact on treatment outcome.. Journal of Child and Family Studies, 2019(Feb): p. 1–11.
    1. Storebo O.J., et al.. Attachment Competences in Children With ADHD During the Social-Skills Training and Attachment (SOSTRA) Randomized Clinical Trial. J Atten Disord, 2015. 19(10): p. 865–71. doi: 10.1177/1087054713520220
    1. Hesse E., & Main M. Frightened, threatening, and dissociative parental behavior in low-risk samples: description, discussion, and interpretations. Dev Psychopathol, 2006. 18(2): p. 309–43. doi: 10.1017/S0954579406060172
    1. Madigan S., Bakermans-Kranenburg M.J., Van IJzendoorn, Moran M.H., Pederson D.R. & Benoit, D. Unresolved states of mind, anomalous parental behavior, and disorganized attachment: A review and meta-analysis of a transmission gap.. Attachment & Human Development 2006. 8: p. 89–111.
    1. Greenberg M. Attachment and Psychopathology in Childhood., in Handbook of Attachment: Theory, Research and Clinical Applications., Cassidy J.S., P.R., Editor. 1999, Guilford Press: New York. p. 469–96.
    1. Weinfield NS, Sroufe LA, Egeland B, Carlson EA. The Nature of Individual Differences in Infant-Caregiver Attachment., in Handbook of Attachment: Theory, Research, and Clinical Applications. Cassidy J. & Shaver P., editors. 1999, Guilford Press: New York, NY. p. pp. 68–88.
    1. Berlin L., Zeanah C., & Lieberman A. Prevention and intervention programs to support early attachment security: A move to the level of the community. in Handbook of Attachment: Theory, research, and clinical applications. 2016, The Guildford Press: New York. p. 739–758.
    1. Bakermans-Kranenburg M.J., van IJzendoorn M.H., and Juffer F. Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychol Bull, 2003. 129(2): p. 195–215. doi: 10.1037/0033-2909.129.2.195
    1. Beijersbergen M.D., et al.. Remaining or becoming secure: parental sensitive support predicts attachment continuity from infancy to adolescence in a longitudinal adoption study. Dev Psychol, 2012. 48(5): p. 1277–82. doi: 10.1037/a0027442
    1. Hoffman K., Cooper G. & Powell B. Raising a secure child. 2017, New York, NY Guilford Press.
    1. Kim M., Woodhouse S. and Dai C. Learning to provide children with a secure base and a safe haven: The Circle of Security‐Parenting (COS‐P) group intervention. Journal of Clinical Psychology, 2018. 74(8): p. 1319–1332. doi: 10.1002/jclp.22643
    1. Maxwell A.M., et al.. Parent and practitioner perspectives on Circle of Security Parenting (COS-P): A qualitative study. Infant Ment Health J, 2021. 42(3): p. 452–468. doi: 10.1002/imhj.21916
    1. Yaholkoski A., Hurl K & Theule J. Efficacy of the Circle of Security Intervention: A Meta-Analysis. Journal of Infant Child and Adolescent Psychotherapy 2016. 15(2): p. 95–103.
    1. Cassidy J., et al.. Enhancing attachment security in the infants of women in a jail-diversion program. Attach Hum Dev, 2010. 12(4): p. 333–53. doi: 10.1080/14616730903416955
    1. Cassidy J., et al.. Enhancing infant attachment security: an examination of treatment efficacy and differential susceptibility. Dev Psychopathol, 2011. 23(1): p. 131–48. doi: 10.1017/S0954579410000696
    1. Hoffman K.T., et al.. Changing toddlers’ and preschoolers’ attachment classifications: the Circle of Security intervention. J Consult Clin Psychol, 2006. 74(6): p. 1017–26. doi: 10.1037/0022-006X.74.6.1017
    1. Dehghani A., Malekpour M., Abedi A. & Amiri S. The efficacy of circle of security on attachment and well-being in preschool children. Management Science Letters 2014. 4: p. 607–612.
    1. Huber A., McMahon C. and Sweller N. Improved child behavioural and emotional functioning after Circle of Security 20-week intervention. Attach Hum Dev, 2015. 17(6): p. 547–69. doi: 10.1080/14616734.2015.1086395
    1. Huber A., McMahon C. and Sweller N. Improved Parental Emotional Functioning After Circle of Security 20-Week Parent–Child Relationship Intervention. JChild Family Stud, 2016. 25(8): p. 2526–40.
    1. Huber A., McMahon C. and Sweller N. Efficacy of the 20-Week Circle of Security Intervention: Changes in Caregiver Reflective Functioning, Representations, and Child Attachment in an Australian Clinical Sample. Infant Ment Health J, 2015. 36(6): p. 556–74. doi: 10.1002/imhj.21540
    1. Cassidy J., et al.. Circle of Security-Parenting: A randomized controlled trial in Head Start. Dev Psychopathol, 2017. 29(2): p. 651–673. doi: 10.1017/S0954579417000244
    1. Mothander R.P., Furmark C. & Neander K. Adding “Circle of Security–Parenting” to treatment as usual in three Swedish infant mental health clinics. Effects on parents’ internal representations and quality of parent‐infant interaction. Scandinavian Journal of Psychology, 2018. 59: p. 262–272. doi: 10.1111/sjop.12419
    1. Kaufman J., et al.. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. Journal Of The American Academy Of Child And Adolescent Psychiatry, 1997. 36(7): p. 980–988. doi: 10.1097/00004583-199707000-00021
    1. Reynolds R. & Kamphaus C. Intellectual Assessment Scales and Reynolds Intellectual Screeining Test Professional Manual. Psychological Assessment Resources. 2003. Psychological Assessment Resources.
    1. Feldman R., Parenting behavior as the environment where children grow. in Cambridge handbooks in psychology. The Cambridge handbook of environment in human development, Mayes L.C. & Lewis M., editors. 2012, Cambridge University Press. p. p. 535–567.
    1. Feldman R. and Klein P.S. Toddlers’ self-regulated compliance to mothers, caregivers, and fathers: implications for theories of socialization. Dev Psychol, 2003. 39(4): p. 680–92. doi: 10.1037/0012-1649.39.4.680
    1. Keren M., et al.. Relations between parents’ interactive style in dyadic and triadic play and toddlers’ symbolic capacity. Am J Orthopsychiatry, 2005. 75(4): p. 599–607. doi: 10.1037/0002-9432.75.4.599
    1. Feldman R. and Eidelman A.I. Neonatal state organization, neuromaturation, mother-infant interaction, and cognitive development in small-for-gestational-age premature infants. Pediatrics, 2006. 118(3): p. e869–78. doi: 10.1542/peds.2005-2040
    1. Feldman R. and Masalha S. Parent-child and triadic antecedents of children’s social competence: cultural specificity, shared process. Dev Psychol, 2010. 46(2): p. 455–67. doi: 10.1037/a0017415
    1. Achenbach T.M. The Achenbach system of empirically based assessment (ASEBA): Development, findings, theory, and applications. 2009. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.
    1. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Vol. , text revision. 2000, Washington, DC: American Psychiatric Association.
    1. Warnick E.M., et al.. Selecting measures for use in child mental health services: a scorecard approach. Adm Policy Ment Health, 2009. 36(2): p. 112–22. doi: 10.1007/s10488-008-0203-x
    1. Measelle J.R., John O.P., Ablow J.C., Cowan P.A. & Cowan C.P. Can children provide coherent, stable, and valid self-reports on the big five dimensions? A longitudinal study from ages 5 to 7. J Pers Soc Psychol., 2005. 89(1): p. 90–106. doi: 10.1037/0022-3514.89.1.90
    1. Ringoot A.P., et al.. Young children’s self-reported emotional, behavioral, and peer problems: the Berkeley Puppet Interview. Psychol Assess, 2013. 25(4): p. 1273–85. doi: 10.1037/a0033976
    1. Ablow J.C., et al.. The MacArthur Three-City Outcome Study: evaluating multi-informant measures of young children’s symptomatology. J Am Acad Child Adolesc Psychiatry, 1999. 38(12): p. 1580–90. doi: 10.1097/00004583-199912000-00020
    1. Eyberg S.P. & Pincus D. ECBI Eyberg Child Behavior Inventory. 1999: PAR Psychological Assessment Resources, Inc.
    1. Burns G.L., Patterson D.R., Nussbaum B.R., & Parker C.M. Disruptive behaviors in an outpatient paediatric population: Additional standardization data on the Eyberg Child Behavior Inventory. Consulting & Clinical Psychology, 1991. 3: p. 202–207.
    1. Hutchings J., Bywater T., Williams M.E., Whitaker C., Lane E., & Shakespeare K. The extended school aged Incredible Years parent programme Child and Adolescent Mental Health, 2011. 16(3): p. 136–143. doi: 10.1111/j.1475-3588.2010.00590.x
    1. Goodman R., et al.. Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br.J.Psychiatry, 2000. 177: p. 534–539. doi: 10.1192/bjp.177.6.534
    1. Niclasen J., et al.. Psychometric properties of the Danish Strength and Difficulties Questionnaire: the SDQ assessed for more than 70,000 raters in four different cohorts. PLoS One, 2012. 7(2): p. e32025. doi: 10.1371/journal.pone.0032025
    1. Niclasen J., et al.. A confirmatory approach to examining the factor structure of the Strengths and Difficulties Questionnaire (SDQ): a large scale cohort study. J Abnorm Child Psychol, 2013. 41(3): p. 355–65. doi: 10.1007/s10802-012-9683-y
    1. Szomlaiski N., et al.. Validity and clinical feasibility of the ADHD rating scale (ADHD-RS) A Danish Nationwide Multicenter Study. Acta Paediatrica, 2009. 98(2): p. 397–402. doi: 10.1111/j.1651-2227.2008.01025.x
    1. DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD rating scale—IV. 1998, New York: The Guilford Press.
    1. Fabes R.A., Poulin R. E., Eisenberg N., Madden-Derdich D. A. The Coping with Children’s Negative Emotions Scale (CCNES): Psychometric properties and relations with children’s emotional competence. Marriage & Family Review, 2002. 34(3–4): p. 285–310.
    1. Luyten P., et al.. The parental reflective functioning questionnaire: Development and preliminary validation. PLoS One, 2017. 12(5): p. e0176218. doi: 10.1371/journal.pone.0176218
    1. De Roo M., et al.. Advancing Optimal Development in Children: Examining the Construct Validity of a Parent Reflective Functioning Questionnaire. JMIR Pediatr Parent, 2019. 2(1): p. e11561. doi: 10.2196/11561
    1. Pazzagli C., Delvecchio E., Raspa V., Mazzeschi C., Luyten P. The parental reflective functioning questionnaire in mothers and fathers of school-aged children. J. Child Fam. Stud., 2018. 27: p. 80–90.
    1. Berry J. and Jones W.H. The Parental Stress Scale: Initial Psychometric Evidence. Journal of Social and Personal Relationships, 1995. 2: p. 463–472.
    1. Moran P., Leese M., Lee T., Walters P., Thornicroft G., & Mann A. Standardised Assessment of Personality–Abbreviated Scale (SAPAS): Preliminary validation of a brief screen for personality disorder. British Journal of Psychiatry, 2003. 183: p. 228–232. doi: 10.1192/bjp.183.3.228
    1. Derogatis L.R., Lipman R. S., & Covi L., SCL-90: An outpatient psychiatric rating scale: Preliminary report. Psychopharmacology Bulletin, 1973. 9: p. 13–28.
    1. Derogatis L.R., Brief Symptom Inventory-18 (BSI-18): Administration, scoring, and procedures manual. 2000, Minneapolis: National Computer Systems.
    1. Bech P., et al.. The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. J Affect Disord 2001. 66: p. 159–164. doi: 10.1016/s0165-0327(00)00309-8
    1. Bech P., et al.. Psychometric evaluation of the Major Depression Inventory (MDI) as depression severity scale using the LEAD (Longitudinal Expert Assessment of All Data) as index of validity. BMC Psychiatry, 2015. 15: p. 190. doi: 10.1186/s12888-015-0529-3
    1. Collins N.L. Working models of attachment: Implications for explanation, emotion, and behavior. Journal of Personality and Social Psychology, 1996. 71: p. 810–832. doi: 10.1037//0022-3514.71.4.810
    1. Collins, N.L., Read., S. J. Adult attachment scale. Unpublished manuscript. .
    1. Bakermans-Kranenburg M., Van IJzendoorn M.H. and Juffer F. Less is more: Meta-analytic arguments for the use of sensitivity-focused interventions, in Promoting positive parenting: An attachment-based intervention, M.J.v.I. B.-K. Juffer F, Editor. 2008, Taylor & Francis: New York. p. p. 59–74.
    1. Sydes M., Spiegelhalter DJ, Altman DG, Babiker AB, Parmar MK DMOCLES Group Systematic qualitative review of the literature on data monitoring committees for randomized controlled trials. Clin Trials, 2004. 1(1): p. 60–79. doi: 10.1191/1740774504cn004rr

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