Effects of Attachment and Child Health (ATTACH™) Parenting Program on Parent and Child Outcomes

• In Event: Parenting intervention

Abstract

Background:
High-risk parents affected by toxic stressors (e.g., family violence, low income) often have difficulty parenting their young children and demonstrate lower sensitivity towards their children’s needs. This predisposes children to insecure attachment (Letourneau, 2015), and increased risk for mental (Sroufe, 2005) and physical health problems, including increased inflammation across the lifespan (Puig et al., 2013; Shonkoff, 2016). Parental reflective function (PRF), i.e., parents’ capacity to understand their own and their child's thoughts, feelings, and mental states, likely underpins parental sensitivity, and may buffer the impacts of toxic stressors on children (Fonagy, 2013). PRF may be modifiable (Letourneau, 2020; Suchman, 2008); however, evidence-based interventions focused on PRF are needed to support at-risk families and promote parent and child health and developmental outcomes.

Purpose:
We developed and pilot tested ATTACH™, a 10-session, one-on-one, manualized PRF-based program designed for high-risk families (Anis, 2021), on parents’ sensitivity, PRF, and depression, children’s attachment, development and behavior, as well as gene expression linked to inflammation. ATTACH™ targets PRF to assist parents in gaining an understanding of mental states—both how their own mental states may impact their children, and how children's mental states might impact them in turn. We hypothesized that ATTACH™ would improve parents’ sensitivity to their child, improve PRF, reduce their depressive symptoms, and improve children’s attachment security, development, and behaviour, and produce changes in immune cell gene expression.

Methods:
We tested ATTACH™ in seven pilot studies (randomized control trials and quasi-experimental) with parent-child (0-5 years) pairs (n=64). We recruited participants from community agencies serving low-income families and those affected by family violence and randomly assigned pairs to treatment or wait-list control groups. We collected data pre- and post-intervention using the Parent-Child Interaction Teaching Scale to assess parental sensitivity, Reflective Function Scale to assess PRF, Edinburgh Postnatal Depression Scale to assess maternal depression, Strange Situation Procedure to assess attachment security, Ages and Stages Questionnaire – 3rd edition/Child Behaviour Checklist to assess child development and behavioral problems, and dried blood spots to assay RNA and assess the Conserved Transcriptional Response to Adversity (CTRA) (Cole, 2019), a pattern of gene expression predicted by exposure to adversity, associated with disease risk, and is characterized by up-regulated pro-inflammatory and down-regulated anti-viral gene transcripts. We employed analysis of covariance, t-tests, and multiple regression modeling.

Results:
ATTACH™ significantly improved parental sensitivity (p<.01) and PRF (p<.01; Letourneau, 2020). It improved the likelihood of secure attachment (p<.01) (Anis, 2022) and child development outcomes, i.e., improved problem-solving (p<.00; Anis, 2020) and executive function (p<.05), and fewer behavioral problems (p<.04) (Letourneau, in review). It also predicted lower mother and child CTRA scores, indicating healthier immune cell gene expression profiles (p<0.04; Ross, 2021), and a trend towards reduced parental depressive symptoms (Anis, 2022).

Conclusion/Implications:
ATTACH™ has positive effects on high-risk children and parents, likely driven by improvements in PRF, and suggesting that ATTACH™ can ameliorate the effects of toxic stress on child outcomes. The program is currently being scaled in clinical community settings across Canada, thus findings stand to be replicated in naturalistic settings.

Group Authors

Attachment and Child Health (ATTACHTM), University of Calgary, Canada.

Authors

• Nicole Letourneau, University of Calgary (U of C)
  Presenting Author

• Lubna Anis, University of Calgary

• Kharah Ross, Athabasca University

• Henry Ntanda, University of Calgary

• Martha Hart, University of Calgary

• Steve W Cole, University of California, Los Angeles