A DESCRIPTIVE STUDY OF A COMMUNITY-BASED HOME-VISITING PROGRAM WITH PRESCHOOL CHILDREN PRENATALLY EXPOSED TO ALCOHOL
Main Article Content
Keywords
Attachment, preschool children, prenatal exposure to alcohol, Fetal Alcohol Spectrum Disorder, Circle of Security
Abstract
Background
Research suggests that prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD) increases the risk of insecure caregiver-child attachment and related negative child emotional-behavioural outcomes. Research also shows positive effects of attachment-focused interventions in preventing disrupted caregiver-child attachment relationships; however, such interventions have not been specifically adapted for children with FASD.
Objectives
This paper describes the implementation, challenges, and results of a community home-based attachment intervention, Circle of Security® (COS), with preschool children affected by PAE/FASD in Manitoba, Canada.
Methods
Twelve caregiver-child dyads completed the FASD adapted COS intervention. Children’s ages ranged from 2–5 years.
Results
Results support a positive influence of this individualized intervention on child behaviour and parent efficacy. There was a significant reduction in parent stress that was maintained at 3-month follow-up, and a clinically significant reduction in child behavioural issues was noted. Children showed increased ability to communicate their needs more effectively to their parent. Parents also showed an improvement in their ability to attend to their child’s cues.
Conclusions
This study supports the use of community home-based attachment intervention for caregivers of children with PAE/FASD.
Research suggests that prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD) increases the risk of insecure caregiver-child attachment and related negative child emotional-behavioural outcomes. Research also shows positive effects of attachment-focused interventions in preventing disrupted caregiver-child attachment relationships; however, such interventions have not been specifically adapted for children with FASD.
Objectives
This paper describes the implementation, challenges, and results of a community home-based attachment intervention, Circle of Security® (COS), with preschool children affected by PAE/FASD in Manitoba, Canada.
Methods
Twelve caregiver-child dyads completed the FASD adapted COS intervention. Children’s ages ranged from 2–5 years.
Results
Results support a positive influence of this individualized intervention on child behaviour and parent efficacy. There was a significant reduction in parent stress that was maintained at 3-month follow-up, and a clinically significant reduction in child behavioural issues was noted. Children showed increased ability to communicate their needs more effectively to their parent. Parents also showed an improvement in their ability to attend to their child’s cues.
Conclusions
This study supports the use of community home-based attachment intervention for caregivers of children with PAE/FASD.
References
1. Bowlby J. Attachment and loss (2nd ed. Vol. 1). New York: Basic Books; 1969.
2. Bowlby J. Attachment theory and its therapeutic implications. Adolesc Psychiatr 1978;6:5–33.
3. Bretherton I and Munholland, K. Internal working models in attachment relationships: Elaborating a central construct in attachment theory (Shaver, JCP Ed.). New York: Guilford Press; 2008.
4. O’Connor, MJ, Kogan, N, and Findlay, R. Prenatal alcohol exposure and attachment behavior in children. Alcohol Clin Exp Res 2002; 26(10), 1592–602. doi:10.1097/01.ALC.0000034665.79909.F0
5. O’Connor, MJ, Sigman, M, and Brill, N. Disorganization of attachment in relation to maternal alcohol consumption. J Consult Clin Psychol 1987;55(6):831–6.
6. O’Connor, MJ, Sigman, M, and Brill, N. Disorganization of attachment in relation to maternal alcohol consumption. J Consult Clin Psychol 1987;55(6):831–36.
7. Molteno CD, Jacobson JL, Carter RC, et al. Infant emotional withdrawal: a precursor of affective and cognitive disturbance in fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2014; 38(2):479–88. doi:10.1111/acer.12240
8. O’Connor MJ, Sigman M, and Brill N. Disorganization of attachment in relation to maternal alcohol consumption. J Consult Clin Psychol 1987;55(6):831–36.
9. Hanlon-Dearman A, Green CR, Andrew G, et al. Anticipatory guidance for children and adolescents with Fetal Alcohol Spectrum Disorder (FASD): practice points for primary health care providers. J Popul Ther Clin Pharmacol 2015;22(1):e27–56.
10. Lange S, Shield K, Rehm J, and Popova S. Prevalence of fetal alcohol spectrum disorders in child care settings: a meta-analysis. Pediatrics 2013;132(4):e980–995. doi:10.1542/peds.2013-0066.
11. Koponen AM, Kalland M, and Autti-Ramo I. Caregiving environment and socio-emotional development of foster-placed FASD-children. Child Youth Serv Rev 2009;31:1049–56. doi:10.1016/j.childyouth.2009.05.006
12. Koponen AM, Kalland M, and Autti-Ramo I. Caregiving environment and socio-emotional development of foster-placed FASD-children. Child Youth Serv Rev 2009;31:1049–56. doi:10.1016/j.childyouth.2009.05.006
13. Bertrand J. Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects. Res Dev Disabil 2009;30(5):986–1006. doi:10.1016/j.ridd.2009.02.003
14. O’Connor MJ, Frankel F, Paley B, et al. A controlled social skills training for children with fetal alcohol spectrum disorders. J Consult Clin Psychol 2006;74(4):639–648. doi:2006-09621-001 [pii]
15. Olson HC, Oti R, Gelo J, and Beck S. "Family matters:" fetal alcohol spectrum disorders and the family. Dev Disabil Res Rev 2009;15(3):235–49. doi:10.1002/ddrr.65
16. Paley B and O’Connor MJ. Behavioral interventions for children and adolescents with fetal alcohol spectrum disorders. Alcohol Res Health 2011;34(1):64–75.
17. Paley B and O’Connor MJ. Intervention for individuals with fetal alcohol spectrum disorders: treatment approaches and case management. Dev Disabil Res Rev 2009;15(3):258–67. doi:10.1002/ddrr.
18. Paley B and O’Connor M J. Behavioral interventions for children and adolescents with fetal alcohol spectrum disorders. Alcohol Res Health 2011;34(1):64–75.
19. Peadon E, Rhys-Jones B, Bower C, and Elliott EJ. Systematic review of interventions for children with Fetal Alcohol Spectrum Disorders. BMC Pediatr 2009;9:35. doi:1471–2431-9-35 [pii]J
20. Premji S, Benzies K, Serrett K, and Hayden KA. Research-based interventions for children and youth with a Fetal Alcohol Spectrum Disorder: revealing the gap. Child Care Health Dev 2007;33(4):389–97; discussion 398–400. doi:CCH692 [pii] 10.1111/j.1365-2214.2006.00692.x
21. Olson HC, Oti R, Gelo J, and Beck S. "Family matters:" fetal alcohol spectrum disorders and the family. Dev Disabil Res Rev2009;15(3):235–49. doi:10.1002/ddrr.65
22. Dunst CJ and Kassow DZ. Caregiver sensitivity, contingent social responsiveness, and secure infant attachment. J Early Intensive Behav Intervent 2008;5(1).
23. Fonagy P, Steele H, and Steele M. Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. Child Dev 1991;62(5):15. doi:10.1111/1467-8624.ep9112161635
24. Pillhofer M, Spangler G, Bovenschen I, et al. Pilot study of a program delivered within the regular service system in Germany: effect of a short-term attachment-based intervention on maternal sensitivity in mothers at risk for child abuse and neglect. Child Abuse Negl 2015;42:163–73. doi:10.1016/j.chiabu.2014.07.007
25. Suess GJ, Bohlen U, Carlson EA, et al. Effectiveness of attachment based STEEP intervention in a German high-risk sample. Attach Hum Dev 2016;1–18. doi:10.1080/14616734.2016.1165265
26. Pillhofer M, Spangler G, Bovenschen I, et al. Pilot study of a program delivered within the regular service system in Germany: effect of a short-term attachment-based intervention on maternal sensitivity in mothers at risk for child abuse and neglect. Child Abuse Negl 2015;42:163–73. doi:10.1016/j.chiabu.2014.07.007
27. Marvin R, Cooper G, Hoffman K, and Powell B. The Circle of Security project: attachment-based intervention with caregiver-pre-school child dyads. Attach Hum Dev 2002;4(1):107–24. doi:10.1080/14616730252982491
28. Ainsworth MD and Bell SM. Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Dev 1070;41(1):49–67.
29. Hoffman KT, Marvin RS, Cooper G, and Powell, B. Changing toddlers’ and preschoolers’ attachment classifications: the Circle of Security intervention. J Consult Clin Psychol 2006;74(6):1017–26. doi:10.1037/0022-006X.74.6.1017
30. Marvin R, Cooper G, Hoffman K, and Powell B. The Circle of Security project: attachment-based intervention with caregiver-pre-school child dyads. Attach Hum Dev 2002;4(1):107–24. doi:10.1080/14616730252982491
31. Zanetti C, Powell B, Cooper G, and Hoffman K. The Circle of Security intervention: Using the therapeutic relationship to ameliorate attachment security in disorganized dyads. Disorg Attach Care 2011;318–42.
32. Hoffman KT, Marvin RS, Cooper G, and Powell B. Changing toddlers’ and preschoolers’ attachment classifications: the Circle of Security intervention. J Consult Clin Psychol 2006;74(6):1017–26. doi:10.1037/0022-006X.74.6.1017
33. Hoffman KT, Marvin RS, Cooper G, and Powell B. Changing toddlers’ and preschoolers’ attachment classifications: the Circle of Security intervention. J Consult Clin Psychol 2006;74(6):1017–26. doi:10.1037/0022-006X.74.6.1017
34. Mercer J. Examining Circle of Security TM: A review of research and theory. Res Social Work Pract 2015;25(3), 11. doi: 10.1177/1049731514536620
35. Marvin R, Cooper G, Hoffman K, and Powell B. The Circle of Security project: attachment-based intervention with caregiver-pre-school child dyads. Attach Hum Dev 2002;4(1):107–24. doi:10.1080/14616730252982491
36. Ainsworth MD and Bell SM. Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Dev 1970;41(1):49–67.
37. Chudley AE, Conry J, Cook JL, et al. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Ottawa: Public Health Agency of Canada’s National Advisory Committee on Fetal Alcohol Spectrum Disorder; 2005.
38. Arnold DS, O’Leary SG, Wolff LS, and Acker MM. The parenting scale: A measure of dysfunctional parenting in discipline situations. Psychol Asses 1993;5(2):137–44.
39. Abidin R, Ed. Parenting Stress Index™, 3rd Edition (PSI™-3). Available at: http://www4.parinc.com/Products/Product.aspx?ProductID=PSI
40. Lovibond SH and Lovibond PF. Manual for the Depression Anxiety Stress Scales. (2nd. Ed.) Sydney: Psychology Foundation; 1995.
41. Ford T, Hutchings J, Bywater T, et al. Strengths and Difficulties Questionnaire Added Value Scores: evaluating effectiveness in child mental health interventions. Br J Psychiatr 2009;194(6):552–8. doi: 10.1192/bjp.bp.108.052373.
42. Goodman A & Goodman R. Strengths and difficulties questionnaire as a dimensional measure of child mental health. J Am Acad Child Adolesc Psychiatr 2009;48(4):400–3. doi: 10.1097/CHI.0b013e3181985068.
43. Goodman R. Psychometric properties of the Strengths and Difficulties Questionnaire (SDQ). J Am Acad Child Adolescent Psychiatr 2001;40:1337–45.
44. Goodman R, Renfrew D, Mullick M. Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolescent Psychiatr 2000;9:129–4.
45. Bowen DJ, Kreuter M, Spring B, et al. How we design feasibility studies. Am J Prev Med 2009;36(5):452–57. doi:10.1016/j.amepre.2009.02.002
46. Letourneau N, Tryphonopoulos P, Giesbrecht G, et al. Narrative and Meta-Analytic Review of Interventions Aiming to Improve Maternal-Child Attachment Security. Infant Ment Health J 2015;36(4):366–87. doi:10.1002/imhj.21525
47. Huber A, McMahon CA, and Sweller N. Efficacy of the 20-Week Circle of Security Intervention: Changes in Caregiver Reflective Functioning, Representations, and Child Attachment in an Australian Clinical Sample. Infant Ment Health J 2015;36(6):556–74. doi:10.1002/imhj.21540
48. Suchman NE, DeCoste C, Castiglioni N, et al. The Mothers and Toddlers Program, an attachment-based parenting intervention for substance-using women: post-treatment results from a randomized clinical pilot. Attach Hum Dev 2010;12(5):483–504. doi:10.1080/14616734.2010.501983
49. Suchman NE, DeCoste C, Leigh D, and Borelli J. Reflective functioning in mothers with drug use disorders: implications for dyadic interactions with infants and toddlers. Attach Hum Dev 2010;12(6):567–85. doi:10.1080/14616734.2010
50. Huber A, McMahon CA, and Sweller N. Efficacy of the 20-Week Circle of Security Intervention: Changes in Caregiver Reflective Functioning, Representations, and Child Attachment in an Australian Clinical Sample. Infant Ment Health J 2015;36(6):556–74. doi:10.1002/imhj.21540
51. Allen JG. Mentalizing in the development and treatment of attachment trauma. London: Karnac Books; 2013.
52. Fonagy P. Attachment theory and psychoanalysis. London: Karnac Books; 2001.
53. Fonagy P, Jurist EL, Target M. Affect regulation, mentalization, and the development of the self. New York, NY: Other Press; 2002.
54. gergely g. the role of contingency detection in early affect–regulative interactions and in the development of different types of infant attachment. Social Deve2004;13(3):11. doi:10.1111/j.1467-9507.2004.00277.x
55. Allen JG. Mentalizing in the development and treatmentof attachment trauma. London: Karnac Books; 2013.
56. Fonagy P. Attachment theory and psychoanalysis.London: Karnac Books; 2001.
57. Suchman NE, DeCoste C, Leigh D, and Borelli J.Reflective functioning in mothers with drug use disorders: implications for dyadic interactions with infants and toddlers. Attach Hum Dev 2010;12(6):567–85.doi:10.1080/14616734.2010
58. Fraley RC and Spieker SJ. (2003). Are infant attachment patterns continuously or categorically distributed? Ataxometric analysis of strange situation behavior. DevPsychol 39(3):387–404.
59. National Scientific Council on the Developing Child. Young children develop in an environment of relationships. Available at://www.developingchild.net/10.1186/1471-2431-9-35
60. Hanlon-Dearman A, Green CR, Andrew G, LeBlancN, and Cook JL. Anticipatory guidance for children and adolescents with Fetal Alcohol Spectrum Disorder (FASD): practice points for primary health care providers. J Popul Ther Clin Pharmacol 2015;22(1):e27–56.
61. O’Connor MJ, Kogan N, and Findlay R. Prenatal alcohol exposure and attachment behavior in children. Alcohol Clin Exp Res 2002;26(10):1592–602. doi:10.1097/01.ALC.0000034665.79909.F0
2. Bowlby J. Attachment theory and its therapeutic implications. Adolesc Psychiatr 1978;6:5–33.
3. Bretherton I and Munholland, K. Internal working models in attachment relationships: Elaborating a central construct in attachment theory (Shaver, JCP Ed.). New York: Guilford Press; 2008.
4. O’Connor, MJ, Kogan, N, and Findlay, R. Prenatal alcohol exposure and attachment behavior in children. Alcohol Clin Exp Res 2002; 26(10), 1592–602. doi:10.1097/01.ALC.0000034665.79909.F0
5. O’Connor, MJ, Sigman, M, and Brill, N. Disorganization of attachment in relation to maternal alcohol consumption. J Consult Clin Psychol 1987;55(6):831–6.
6. O’Connor, MJ, Sigman, M, and Brill, N. Disorganization of attachment in relation to maternal alcohol consumption. J Consult Clin Psychol 1987;55(6):831–36.
7. Molteno CD, Jacobson JL, Carter RC, et al. Infant emotional withdrawal: a precursor of affective and cognitive disturbance in fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2014; 38(2):479–88. doi:10.1111/acer.12240
8. O’Connor MJ, Sigman M, and Brill N. Disorganization of attachment in relation to maternal alcohol consumption. J Consult Clin Psychol 1987;55(6):831–36.
9. Hanlon-Dearman A, Green CR, Andrew G, et al. Anticipatory guidance for children and adolescents with Fetal Alcohol Spectrum Disorder (FASD): practice points for primary health care providers. J Popul Ther Clin Pharmacol 2015;22(1):e27–56.
10. Lange S, Shield K, Rehm J, and Popova S. Prevalence of fetal alcohol spectrum disorders in child care settings: a meta-analysis. Pediatrics 2013;132(4):e980–995. doi:10.1542/peds.2013-0066.
11. Koponen AM, Kalland M, and Autti-Ramo I. Caregiving environment and socio-emotional development of foster-placed FASD-children. Child Youth Serv Rev 2009;31:1049–56. doi:10.1016/j.childyouth.2009.05.006
12. Koponen AM, Kalland M, and Autti-Ramo I. Caregiving environment and socio-emotional development of foster-placed FASD-children. Child Youth Serv Rev 2009;31:1049–56. doi:10.1016/j.childyouth.2009.05.006
13. Bertrand J. Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects. Res Dev Disabil 2009;30(5):986–1006. doi:10.1016/j.ridd.2009.02.003
14. O’Connor MJ, Frankel F, Paley B, et al. A controlled social skills training for children with fetal alcohol spectrum disorders. J Consult Clin Psychol 2006;74(4):639–648. doi:2006-09621-001 [pii]
15. Olson HC, Oti R, Gelo J, and Beck S. "Family matters:" fetal alcohol spectrum disorders and the family. Dev Disabil Res Rev 2009;15(3):235–49. doi:10.1002/ddrr.65
16. Paley B and O’Connor MJ. Behavioral interventions for children and adolescents with fetal alcohol spectrum disorders. Alcohol Res Health 2011;34(1):64–75.
17. Paley B and O’Connor MJ. Intervention for individuals with fetal alcohol spectrum disorders: treatment approaches and case management. Dev Disabil Res Rev 2009;15(3):258–67. doi:10.1002/ddrr.
18. Paley B and O’Connor M J. Behavioral interventions for children and adolescents with fetal alcohol spectrum disorders. Alcohol Res Health 2011;34(1):64–75.
19. Peadon E, Rhys-Jones B, Bower C, and Elliott EJ. Systematic review of interventions for children with Fetal Alcohol Spectrum Disorders. BMC Pediatr 2009;9:35. doi:1471–2431-9-35 [pii]J
20. Premji S, Benzies K, Serrett K, and Hayden KA. Research-based interventions for children and youth with a Fetal Alcohol Spectrum Disorder: revealing the gap. Child Care Health Dev 2007;33(4):389–97; discussion 398–400. doi:CCH692 [pii] 10.1111/j.1365-2214.2006.00692.x
21. Olson HC, Oti R, Gelo J, and Beck S. "Family matters:" fetal alcohol spectrum disorders and the family. Dev Disabil Res Rev2009;15(3):235–49. doi:10.1002/ddrr.65
22. Dunst CJ and Kassow DZ. Caregiver sensitivity, contingent social responsiveness, and secure infant attachment. J Early Intensive Behav Intervent 2008;5(1).
23. Fonagy P, Steele H, and Steele M. Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. Child Dev 1991;62(5):15. doi:10.1111/1467-8624.ep9112161635
24. Pillhofer M, Spangler G, Bovenschen I, et al. Pilot study of a program delivered within the regular service system in Germany: effect of a short-term attachment-based intervention on maternal sensitivity in mothers at risk for child abuse and neglect. Child Abuse Negl 2015;42:163–73. doi:10.1016/j.chiabu.2014.07.007
25. Suess GJ, Bohlen U, Carlson EA, et al. Effectiveness of attachment based STEEP intervention in a German high-risk sample. Attach Hum Dev 2016;1–18. doi:10.1080/14616734.2016.1165265
26. Pillhofer M, Spangler G, Bovenschen I, et al. Pilot study of a program delivered within the regular service system in Germany: effect of a short-term attachment-based intervention on maternal sensitivity in mothers at risk for child abuse and neglect. Child Abuse Negl 2015;42:163–73. doi:10.1016/j.chiabu.2014.07.007
27. Marvin R, Cooper G, Hoffman K, and Powell B. The Circle of Security project: attachment-based intervention with caregiver-pre-school child dyads. Attach Hum Dev 2002;4(1):107–24. doi:10.1080/14616730252982491
28. Ainsworth MD and Bell SM. Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Dev 1070;41(1):49–67.
29. Hoffman KT, Marvin RS, Cooper G, and Powell, B. Changing toddlers’ and preschoolers’ attachment classifications: the Circle of Security intervention. J Consult Clin Psychol 2006;74(6):1017–26. doi:10.1037/0022-006X.74.6.1017
30. Marvin R, Cooper G, Hoffman K, and Powell B. The Circle of Security project: attachment-based intervention with caregiver-pre-school child dyads. Attach Hum Dev 2002;4(1):107–24. doi:10.1080/14616730252982491
31. Zanetti C, Powell B, Cooper G, and Hoffman K. The Circle of Security intervention: Using the therapeutic relationship to ameliorate attachment security in disorganized dyads. Disorg Attach Care 2011;318–42.
32. Hoffman KT, Marvin RS, Cooper G, and Powell B. Changing toddlers’ and preschoolers’ attachment classifications: the Circle of Security intervention. J Consult Clin Psychol 2006;74(6):1017–26. doi:10.1037/0022-006X.74.6.1017
33. Hoffman KT, Marvin RS, Cooper G, and Powell B. Changing toddlers’ and preschoolers’ attachment classifications: the Circle of Security intervention. J Consult Clin Psychol 2006;74(6):1017–26. doi:10.1037/0022-006X.74.6.1017
34. Mercer J. Examining Circle of Security TM: A review of research and theory. Res Social Work Pract 2015;25(3), 11. doi: 10.1177/1049731514536620
35. Marvin R, Cooper G, Hoffman K, and Powell B. The Circle of Security project: attachment-based intervention with caregiver-pre-school child dyads. Attach Hum Dev 2002;4(1):107–24. doi:10.1080/14616730252982491
36. Ainsworth MD and Bell SM. Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Dev 1970;41(1):49–67.
37. Chudley AE, Conry J, Cook JL, et al. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Ottawa: Public Health Agency of Canada’s National Advisory Committee on Fetal Alcohol Spectrum Disorder; 2005.
38. Arnold DS, O’Leary SG, Wolff LS, and Acker MM. The parenting scale: A measure of dysfunctional parenting in discipline situations. Psychol Asses 1993;5(2):137–44.
39. Abidin R, Ed. Parenting Stress Index™, 3rd Edition (PSI™-3). Available at: http://www4.parinc.com/Products/Product.aspx?ProductID=PSI
40. Lovibond SH and Lovibond PF. Manual for the Depression Anxiety Stress Scales. (2nd. Ed.) Sydney: Psychology Foundation; 1995.
41. Ford T, Hutchings J, Bywater T, et al. Strengths and Difficulties Questionnaire Added Value Scores: evaluating effectiveness in child mental health interventions. Br J Psychiatr 2009;194(6):552–8. doi: 10.1192/bjp.bp.108.052373.
42. Goodman A & Goodman R. Strengths and difficulties questionnaire as a dimensional measure of child mental health. J Am Acad Child Adolesc Psychiatr 2009;48(4):400–3. doi: 10.1097/CHI.0b013e3181985068.
43. Goodman R. Psychometric properties of the Strengths and Difficulties Questionnaire (SDQ). J Am Acad Child Adolescent Psychiatr 2001;40:1337–45.
44. Goodman R, Renfrew D, Mullick M. Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolescent Psychiatr 2000;9:129–4.
45. Bowen DJ, Kreuter M, Spring B, et al. How we design feasibility studies. Am J Prev Med 2009;36(5):452–57. doi:10.1016/j.amepre.2009.02.002
46. Letourneau N, Tryphonopoulos P, Giesbrecht G, et al. Narrative and Meta-Analytic Review of Interventions Aiming to Improve Maternal-Child Attachment Security. Infant Ment Health J 2015;36(4):366–87. doi:10.1002/imhj.21525
47. Huber A, McMahon CA, and Sweller N. Efficacy of the 20-Week Circle of Security Intervention: Changes in Caregiver Reflective Functioning, Representations, and Child Attachment in an Australian Clinical Sample. Infant Ment Health J 2015;36(6):556–74. doi:10.1002/imhj.21540
48. Suchman NE, DeCoste C, Castiglioni N, et al. The Mothers and Toddlers Program, an attachment-based parenting intervention for substance-using women: post-treatment results from a randomized clinical pilot. Attach Hum Dev 2010;12(5):483–504. doi:10.1080/14616734.2010.501983
49. Suchman NE, DeCoste C, Leigh D, and Borelli J. Reflective functioning in mothers with drug use disorders: implications for dyadic interactions with infants and toddlers. Attach Hum Dev 2010;12(6):567–85. doi:10.1080/14616734.2010
50. Huber A, McMahon CA, and Sweller N. Efficacy of the 20-Week Circle of Security Intervention: Changes in Caregiver Reflective Functioning, Representations, and Child Attachment in an Australian Clinical Sample. Infant Ment Health J 2015;36(6):556–74. doi:10.1002/imhj.21540
51. Allen JG. Mentalizing in the development and treatment of attachment trauma. London: Karnac Books; 2013.
52. Fonagy P. Attachment theory and psychoanalysis. London: Karnac Books; 2001.
53. Fonagy P, Jurist EL, Target M. Affect regulation, mentalization, and the development of the self. New York, NY: Other Press; 2002.
54. gergely g. the role of contingency detection in early affect–regulative interactions and in the development of different types of infant attachment. Social Deve2004;13(3):11. doi:10.1111/j.1467-9507.2004.00277.x
55. Allen JG. Mentalizing in the development and treatmentof attachment trauma. London: Karnac Books; 2013.
56. Fonagy P. Attachment theory and psychoanalysis.London: Karnac Books; 2001.
57. Suchman NE, DeCoste C, Leigh D, and Borelli J.Reflective functioning in mothers with drug use disorders: implications for dyadic interactions with infants and toddlers. Attach Hum Dev 2010;12(6):567–85.doi:10.1080/14616734.2010
58. Fraley RC and Spieker SJ. (2003). Are infant attachment patterns continuously or categorically distributed? Ataxometric analysis of strange situation behavior. DevPsychol 39(3):387–404.
59. National Scientific Council on the Developing Child. Young children develop in an environment of relationships. Available at://www.developingchild.net/10.1186/1471-2431-9-35
60. Hanlon-Dearman A, Green CR, Andrew G, LeBlancN, and Cook JL. Anticipatory guidance for children and adolescents with Fetal Alcohol Spectrum Disorder (FASD): practice points for primary health care providers. J Popul Ther Clin Pharmacol 2015;22(1):e27–56.
61. O’Connor MJ, Kogan N, and Findlay R. Prenatal alcohol exposure and attachment behavior in children. Alcohol Clin Exp Res 2002;26(10):1592–602. doi:10.1097/01.ALC.0000034665.79909.F0