Reactive attachment disorder
Conditions
Interventions
intergrative therapie for attachment and behaviour (ITAB) is a phased treatment in which each phase serves a specific function and depends on success in the previous phase. Initially, the therapist at
Sponsors
Vrije Universiteit
Eligibility
Age
2 Years to 11 Years
Inclusion criteria
Inclusion criteria: Child FactorsChronological age between 5 and 9 years.The child is under a (family) guardianship measure, ensuring referral and continuous funding for the care process through a certified institution.IQ = 70 (measured before the start of the intervention using WPSSI-III-NL/WISC-III-NL/WISC-IV-NL).The child exhibits behavioral problems, weak emotional regulation, and social difficulties (problems interacting with others), based on clinical scores from SEV and SDQ.Living in a foster family, family home, or temporarily in a residential group or foster home, with transition to a permanent foster family.Disturbed patterns of seeking proximity, as measured by the DAI.History of at least three separations from caregivers or loss of significant caregivers.DSM-5 classification: Reactive Attachment Disorder, Persistent, Severe (313.89), diagnosed after a standard intake procedure based on Dekker-van der Sande & Jansen (2010) and Giltaij & Sterkenburg (2017).Children for whom previous interventions aimed at daily guidance and living situations have proven ineffective. This conclusion is drawn when previous interventions indicate that problematic behavior persists.Environmental FactorsStable caregivers who can reflect on their parenting practices and adjust them when necessary, as identified in the intake procedure, reported by foster care guidance, and assessed using the Parental Reflective Functioning Questionnaire (PRFQ).One consistent caregiver (potentially alternating with another stable caregiver) is willing and able to accompany the child to every treatment session and remain present at the treatment location throughout the sessions.It is legally feasible, and foster parents are capable of keeping the child in their home during the treatment period (if already in a permanent foster family).Regular system support is in place:Caregivers and school staff require support in fostering a sensitive and responsive caregiving style and maintaining contact/relationships with the child.They are willing and able to participate in various assessment moments.They are willing to be involved in biannual treatment evaluations.They have access to a computer, smartphone, and internet, along with sufficient computer skills to complete questionnaires.
Exclusion criteria
Exclusion criteria: Child FactorsDiagnosis of Autism Spectrum Disorder (ASD).Fetal Alcohol Spectrum Disorder (FASD) or Sentinel Physical Finding / Static Encephalopathy, with unknown alcohol exposure.Epilepsy.Severe illness.Symptoms requiring frequent or prolonged medical interventions or hospitalizations.Any kind of treatment that is prioritized over ITGG-K&J intervention (including guideline-based interventions).Environmental FactorsFor an extended period, there are no individuals with whom the child can form an attachment relationship. Caregivers do not seek support and are unwilling to follow the therapist’s recommended advice, which is transferred in the third phase of the intervention.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Main Objective:At the end of ITGG-K&J therapy, children exhibit fewer disturbed attachment signals and more proximity-seeking behavior in stressful situations.Measurement Instruments:1. Disturbances of Attachment Interview (DAI) – A semi-structured interview with the caregiver about attachment problems.2. Clinical Observation of Attachment (COA) – Video observation of interactions between the child and the caregiver/researcher.3. List of Signals of (Disturbed) Attachment Behavior (LSVG) – Assessment of eight types of attachment behavior.4. Observation Instrument for Attachment Behavior (OIG) – Assessment of the child’s contact, avoidance, and resistant behavior toward the therapist.5. Proximity-Seeking Behavior Monitor (MNG) – A short questionnaire for caregivers about proximity-seeking behavior.6. Ultra Wideband Tag (UWB-tag) – A sensor measuring the child’s proximity to the therapist during the stress task. | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary Study Parameters / Outcomes:Due to the reduction in disturbed attachment and increased proximity-seeking behavior, the following outcomes are expected:1. Reduction of stress in the child• Empatica EmbracePlus – Measurement of heart rate and respiration during the stress task.2. Reduction of problem behavior in the child• Social-Emotional Questionnaire (SEV) – Assessment of social-emotional problems.• Strengths and Difficulties Questionnaire (SDQ) – Screening of social-emotional problems by parents and teachers.3. Improvement in differentiation between people• Eye-tracking (Tobii Pro Spark) – Measurement of eye movements while viewing faces.4. Improvement in distinguishing emotions of others• NEPSY-II-NL – Subtests for emotion recognition and social understanding.5. Reduction of parenting stress in caregivers• Parental Stress Scale (Dutch) (PSS) – Measures parenting stress through nine questions.Optional: In-Depth Interviews• Interviews with parents, children, and therapists after the study to gain insights into their experiences with ITGG-K&J. | — |
Countries
Netherlands
Contacts
Public ContactM Mesker
Vrije Universiteit
Outcome results
None listed