Interventions Based on Attachment Theory: A Critical Analysis
Cook, Clayton R., Little, Steven G., Akin-Little, Angeleque, Journal of Early Childhood and Infant Psychology
Over the past decade, several researchers have evaluated the efficacy of interventions predicated on elements of attachment theory. The common denominator of these interventions is their focus on improving the quality of the caregiver-child relationship. According to attachment theory, the quality of early caregiver-child interaction patterns set the stage for later (a)typical development (Ainsworth, Blehar, Waters, & Wall, 1978). That is, infants and young children direct a large portion of their behaviors (e.g., crying, looking, babbling) to caregivers, which is intended to secure help for negotiating the demands of their environments (Bowlby, 1982). The extent to which caregivers fail to respond to these cues, the greater the likelihood that the child will manifest some type of attachment disorder and experience the range of possible negative outcomes that accompany such disorders, including poor self-regulation and rejection from peers (Carlson & Sroufe, 1995). Research has also shown that in homes where caregiver-child attachment is characterized as warm and loving, children are likely to develop competence even in the face of adverse conditions (Masten & Coatsworth, 1998).
Given the implications that early attachment bonds have for the development of children, from a preventive standpoint, interventions designed to improve the attachment between caregivers and young ones is a palpable approach to preventing serious social, emotional, or behavioral problems. Many researchers have, in fact, adopted this perspective and implemented attachment-related interventions with caregivers and preschool-aged children as the targets of their interventions. Although there is considerable intuitive appeal to the notion of interventions based on attachment theory, it is important that practitioners are aware of the empirical support for such interventions before they blindly implement them. This logic is consistent with the evidence-based movement that has pervaded many professional disciplines (APA, 2005; Kratochwill, 2003; Kratochwill & Stoiber, 2000, 2002; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000; Weisz & Hawley, 2002).
In August of 2005 the American Psychological Association adopted a policy with regard to evidence-based practice in psychology (EBPP). The purpose of this policy is to promote effective psychological practice by using evidence derived from clinically relevant research (APA, 2005). Specific statements have also been developed by APA's Divisions 16 (Kratochwill, 2003) and 12 (Weisz & Hawley, 2002). The Division 16 procedures, which will be adhered to in the current study, review only research that has been peer-reviewed. Interventions are rated across nine dimensions: (a) measurement, (b) comparison group, (c) primary/secondary outcomes significant, (d) educational/clinical significance, (e) durability of effects, (f) identifiable intervention components, (g) implementation fidelity, (h) replication, and (i) school- or field-based site (see Kratochwill, 2003). The inclusion of comparison groups in a study is given specific importance as without a relevant comparison group it is difficult to fully evaluate the merits of the results. Implementation fidelity is another of the essential characteristics. Also called treatment integrity, it refers to the extent to which an intervention is implemented as designed (Gresham, 1989, 2004). Without adequate implementation fidelity it is impossible to know if any reported results are a function of the intervention.
Meta-Analyses on Attachment Interventions
To date, two meta-analyses have been performed to evaluate the effects of attachment interventions (Bakersmans-Kranenburg, van Ijzendoorn, & Juffer, 2003, 2005), both providing modest support for the efficacy of attachment interventions. The Bakersmans-Kranenburg and colleagues (2003) meta-analysis included 70 studies (N = 842) detailing 88 intervention effects published between 1978 and 2001 on both sensitivity and/or attachment. …