Article : Early Interventions Can Avert or Reduce Disorganized Attachment

Joel Yager, MD reviewing Wright B et al. PLoS One 2017 Jul 14.

A new systematic review and meta-analysis of high-quality, randomized, controlled trials provide greater hope than older meta-analyses did.

Disorganized attachment patterns in infants and children have long been associated with subsequent psychological and behavioral problems, from internalizing and externalizing problems in children through borderline personality disorder in adults. For decades, researchers trying to avert or reverse these patterns have used various “preventive intervention” programs for high-risk mothers and couples, starting prenatally, during infancy, or in early childhood. Most programs have focused on enhancing parenting skills to diminish maternal fright/frightening behavior and to correct disrupted maternal communications during infant-child distress (negative-intrusive behaviors, role confusion, withdrawal, contradictory messages, etc.).

In a systematic review and meta-analysis of randomized, controlled trials through October 2016, investigators identified 14 studies meeting criteria, with enrollments ranging from 43 to 449. The 1816 children were of various ethnicities and were typically selected due to child protection concerns, parental mental illness, social and economic deprivation, or having adolescent mothers. Most studies focused on improving parental sensitivity (understanding and tuning into baby's signals and cues). Controls predominantly received treatment-as-usual. Overall, interventions reduced disorganized attachment, with a small-to-medium effect size; five studies had medium or large effects. Only interventions with >16 sessions outperformed controls. Exploratory analyses suggested that effects were limited for infants aged <6 months but good for those aged 6 to 12 months.


Wright B et al. Decreasing rates of disorganised attachment in infants and young children, who are at risk of developing, or who already have disorganised attachment. A systematic review and meta-analysis of early parenting interventions. PLoS One 2017 Jul 14; 12:e0180858.