Abstract
Parental reflective functioning (PRF) is an important predictor of infant attachment, and interventions that target parent-infant/toddler dyads who are experiencing significant problems have the potential to improve PRF. A range of dyadic interventions have been developed over the past two decades, some of which explicitly target PRF as part of their theory of change, and some that do not explicitly target PRF, but that have measured it as an outcome. However, no meta-analytic review of the impact of these interventions has been carried out to date. The aim of this review was to evaluate the effectiveness of dyadic interventions targeting parents of infant and toddlers, in improving PRF and a number of secondary outcomes. A systematic review and meta-analysis was conducted in which key electronic databases were searched up to October 2018. Eligible studies were identified and data extracted. Data were synthesised using meta-analysis and expressed as both effect sizes and risk ratios. Six studies were identified providing a total of 521 participants. The results of six meta-analyses showed a nonsignificant moderate improvement in PRF in the intervention group (standardised mean difference [SMD]: -0.46; 95% confidence interval [CI] [-0.97, 0.04]) and a significant reduction in disorganised attachment (risk ratio: 0.50; 95% CI [0.27, 0.90]). There was no evidence for intervention effects on attachment security (odds ratio: 0.71; 95% CI [0.19, 2.64]), parent-infant interaction (SMD: -0.10; 95% CI [-0.46, 0.26]), parental depression (SMD: -1.55; 95% CI [-3.74, 0.64]) or parental global distress (SMD:-0.19, 95% CI [-3.04, 22.65]). There were insufficient data to conduct subgroup analysis (i.e. to compare the effectiveness of mentalisation-based treatment with non-mentalization-based treatment interventions). Relational early interventions may have important benefits in improving PRF and reducing the prevalence of attachment disorganisation. The implications for future research are discussed.
Highlights
1.1 Early childhood mental health problemsInfant regulatory disturbances such as excessive crying, feeding or sleeping difficulties and bonding/attachment problems have a high prevalence in many countries
The findings of this review show a moderate trend toward improvement in parental reflective functioning and a significant improvement in disorganised attachment following the provision of a dyadic intervention to high-risk parents in the postnatal period
The included studies targeted a range of parents, including high-risk primiparous women with demographic risk factors (Sadler et al, 2013; Sleed, Slade, & Fonagy, 2020); mothers experiencing mental health problems and high levels of social adversity (Fonagy, Sleed, & Baradon, 2016); mother–infant dyads in prison (Fonagy et al, 2016) or those taking part in substance treatment programs (Suchman et al, 2010)
Summary
Infant regulatory disturbances such as excessive crying, feeding or sleeping difficulties and bonding/attachment problems have a high prevalence in many countries. Some regulatory disturbances are stable over time with one study suggesting that as many as 49.9% of infants and toddlers (aged 12–40 months) show a continuity of emotional and behavioural problems 1 year after initial presentation (Briggs-Gowan, Carter, Bosson-Heenan, Guyer, & Horwitz, 2006). Problems of this nature are significant predictors of longer term difficulties. Individual empirical studies have found an association between disorganised attachment and dissociation (Dutra & Lyons-Ruth, 2005; Lyons-Ruth, 2015); post-traumatic stress disorder (PTSD) (Macdonald et al, 2008) and an increased likelihood of children experiencing symptoms that meet clinical criteria (Borelli et al, 2010)
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