Abstract
Children who live on the margins of society are disadvantaged in achieving their developmental potential because of the lack of a necessary stable environment and nurturing care. Many early prevention programs aim at mitigating such effects, but often the evaluation of their long-term effect is missing. The aim of the study presented here was to evaluate such long-term effects in two prevention programs for children-at-risk growing up in deprived social environments focusing on child attachment representation as the primary outcome as well as on self-reflective capacities of teachers taking care of these children. The latter was a key component for promoting resilient behavior in children. Five hundred and twenty-six children aged 36 to 60 months at risk due to immigration status, low family socio-economic status and child behavior were examined in a cluster-randomized study comparing two preventions, the psychodynamic, attachment-based holistic approach EARLY STEPS (ES) with the classroom based FAUSTLOS (FA) for their efficacy. Primary outcome was the child attachment representation measured by the Manchester Child Attachment Story Task (MCAST). Secondary outcomes were derived from (a) the Caregiver-Teacher Report Form (C-TRF: problem behaviors, including anxiety/depressive symptoms, emotional-reactive and somatic problems, social withdrawal, aggressive behavior, and attention deficit), from (b) the Strength and Difficulties Questionnaire (SDQ, parent version: resilience and wellbeing) and (c) Self-Reflective Scales for teachers (SRS: self-reflective capacities of teachers). Compared to baseline, attachment and behavioral problems improved in both programs. ES led to more secure and more organized attachment representations (medium effect sizes). Aggressive behavior and externalizing problems were reduced in the FA group compared with ES, particularly in boys (medium effect sizes). Self-reflective capacities of the teachers increased only in the ES group. High correlation between children’s attachment type with the number of social risk factors and the increase of problematic social behavior strongly indicate that an increase in teachers’ self-reflective capacities helps to change children’s attachment patterns which thus strengthens the resilience of these children-at-risk [An ethical vote from LPPKJP 2009-02-25 was obtained and the trial registered; Clinical trial registration information: The trial was registered 14.02.2012 (DRKS00003500; https://www.drks.de)].
Highlights
Emotional neglect, experiences of violence, threat and traumatization have severe effects on psychological development as has been demonstrated impressively by many clinical, empirical and interdisciplinary studies (Bohleber, 2000; De Bellis and Thomas, 2003; Becker-Stoll et al, 2009; LeuzingerBohleber et al, 2017a, 2010, 2020)
We have further reduced the potential for biased results by using a large item pool in imputation procedures, which includes variables that may be correlated with missingness, such as baseline aggression and verbal abilities
The sample showed a large percentage of disorganized attachment, with no significant difference between intervention groups at baseline (MCAST – DES 26.3%/DFA 22.0%)
Summary
Experiences of violence, threat and traumatization have severe effects on psychological development as has been demonstrated impressively by many clinical, empirical and interdisciplinary studies (Bohleber, 2000; De Bellis and Thomas, 2003; Becker-Stoll et al, 2009; LeuzingerBohleber et al, 2017a, 2010, 2020). In many studies it is discussed that the specific experience of a child as well as their family and social environment must be taken into account in order to understand the short and long-term consequences of early-life adversities in detail in order to respond to them in an adequate individual way. To mention just one example: A meta-analysis by Colich et al (2019) found that early-life adversity (ELA) involving threat (e.g., violence exposure) was associated with accelerated biological aging across multiple metrics, whereas exposure to deprivation (e.g., neglect, institutional rearing) and low socio-economic status (SES) was not. The authors meta-analyzed 46 studies (n = 64,925) the examining association of ELA with pubertal timing and cellular aging (telomere length and DNA methylation age) in order to understand the short and long-term consequences of early-life adversities in detail and to take corrective action in an individual way. These findings suggest specificity in the types of early environmental experiences associated with accelerated biological aging and highlight the importance of how accelerated aging contributes to health disparities and whether this process can be mitigated through early intervention” (Colich et al, 2019, p. 2)
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