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Background:The quality of attachment is greatly influenced by parental sensitivity. Attachment based interventions are designed to promote parental sensitivity, to change parental mental representations and to improve understanding of the developmental needs of the child. Very few studies have investigated the effect of attachment-based interventions on psychiatric symptoms in children. Targeting parental sensitivity and the parent-child interaction might have an important impact on psychiatric symptoms in a clinical sample of children referred to child psychiatric services.
Objectives: The primary objective is to investigate whether Circle of Security-Parenting (COS-P) has an effect on parental sensitivity in parents of children referred to child psychiatric services. The secondary objectives are to investigate the effect on children's behavioral and emotional symptoms and the parental stress and reflective functioning after 10 weeks of intervention and at the 24 week follow-up. The study is also exploring the effect of parental attachment style, parental stress and parental psychopathology on the effect of the intervention.
Methods: The trial will include 128 families of children (age 3-8 years) who are referred to child psychiatric services in a randomized and controlled design. Included families will be randomized to COS-P+ Treatment as Usual (TAU) or TAU only.
Perspectives: Considering the important impact of the quality of the parent-child relationship on the child's well-being, it is essential to target it in interventions and to investigate the relation with psychiatric symptoms. Generally there is a lack of interventions targeting parental sensitivity in psychiatric child populations. Working with the parents on the child-parent relation, might have an important impact on their children's current psychiatric symptoms and could additionally prevent future psychopathology.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Circle of Security-Parenting | Experimental | 10 weekly, manualized group sessions at the clinic |
|
| Treatment as Usual (TAU) | Other | TAU consists of clinical assessment and treatment. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Circle of Security-Parenting | Other | COS-P is a brief, behavioral and insight oriented therapeutic group approach for parents with the aim to promote parental sensitivity and attachment and autonomy in the parent-child relationship. The parents will participate in ten weekly 1,5-hour sessions at the clinic conducted by two COS-certified therapists. Groups will include 4-5 families at a time. |
| Measure | Description | Time Frame |
|---|---|---|
| Maternal sensitivity | Maternal sensitivity is measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB) | after 10 weeks of intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Maternal Intrusiveness | Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB) | after 10 weeks of intervention |
| Maternal Sensitivity | Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB) |
| Measure | Description | Time Frame |
|---|---|---|
| Major Depression Inventory- mother and partner | Parent questionnaire on their own depressive symptoms. Score range 0-50. Higher scores indicating more severe symptoms. | baseline |
| Revised Adult Attachment Scale (RAAS) |
Inclusion Criteria:
Exclusion Criteria:
For children:
For parents:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Aida Bikic, PhD | Contact | + 45 99 44 62 00 | aida.bikic@rsyd.dk | |
| Søren Dalsgaard, PhD | Contact | sdalsgaard@econ.au.dk |
| Name | Affiliation | Role |
|---|---|---|
| Aida Bikic, PhD | University of Southern Denmark | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Child and Adolescent Mental Health Services | Recruiting | Aabenraa | 6200 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35472058 | Derived | Bikic A, Smith-Nielsen J, Dalsgaard S, Swain J, Fonagy P, Leckman JF. Protocol for a randomized controlled trial comparing the Circle of Security-parenting (COS-P) with treatment as usual in child mental health services. PLoS One. 2022 Apr 26;17(4):e0265676. doi: 10.1371/journal.pone.0265676. eCollection 2022. |
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| ID | Term |
|---|---|
| D006967 | Hypersensitivity |
| ID | Term |
|---|---|
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| D013812 | Therapeutics |
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|
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| Treatment as Usual | Other | TAU consists of clinical assessment and treatment. |
|
|
| 24 week follow-up |
| Maternal Intrusiveness | Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB) | 24 week follow-up |
| Dyadic reciprocity | Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB) | after 10 weeks of intervention |
| Dyadic reciprocity | Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB) | 24 week follow-up |
| Negative states | Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB) | after 10 weeks of intervention |
| Negative states | Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB) | 24 week follow-up |
| Child Behaviour Check List (CBCL)-Total score-parent rated | Parent questionnaire on child symptoms. Score range (0-236). Higher indicates more problems. | after 10 weeks of intervention |
| Child Behaviour Check List (CBCL)-Total score-parent rated | Parent questionnaire on child symptoms. Score range: 0-236. Higher indicates more problems. | 24 week follow-up |
| CBCL-ODD score-parent rated. Score range: 0-26. Higher indicates more problems. | Parent questionnaire on child symptoms | after 10 weeks of intervention |
| CBCL-ODD score-parent rated. Score range: 0-26. Higher indicates more problems. | Parent questionnaire on child symptoms | 24 week follow-up |
| Berkeley Puppet interview | Child interview | after 10 weeks of intervention |
| Berkeley Puppet interview | Child interview | 24 week follow-up |
| Coping with childrens negative emotions scale | Parent questionnaire on their strategies coping with children's negative emotions. Score range 72-504. | baseline |
| Coping with childrens negative emotions scale | Parent questionnaire on their strategies coping with children's negative emotions. Score range 72-504. | after 10 weeks of intervention |
| Coping with childrens negative emotions scale | Parent questionnaire on their strategies coping with children's negative emotions. Score range 72-504. | 24 week follow-up |
| Parental Reflective Functioning Questionnaire | Parent self-report measure that assesses parental reflective functioning or mentalizing. Score range 1-126. | baseline |
| Parental Reflective Functioning Questionnaire | Parent self-report measure that assesses parental reflective functioning or mentalizing. Score range 1-126. | after 10 weeks of intervention |
| Parental Reflective Functioning Questionnaire | Parent self-report measure that assesses parental reflective functioning or mentalizing. Score range 1-126. | 24 week follow-up |
| Eyberg Child Behaviour Inventory (ECBI) | Parent questionnaire on child behavior. Score range 36-252. Higher indicating more problems. | after 10 weeks of intervention |
| Eyberg Child Behaviour Inventory (ECBI) | Parent questionnaire on child behavior. Score range 36-252. Higher indicating more problems. | 24 week follow-up |
Questionnaire regarding the attachment style of the mother and partner. Scofre range 18-90.
| baseline |
| Standardized Assessment of Personality (SAPAS)-mother and partner | A short and simple interview-administered screen for personality disorders. Score range 1-8, higher score indicating more problems. | baseline |
| Strength and Difficulties Questionnaire (SDQ) | Parent questionnaire on the strength and difficulties of the child. Total difficulties score 0-40. Higher indicating more problems. | baseline |
| Strength and Difficulties Questionnaire (SDQ) | Parent questionnaire on the strength and difficulties of the child. Total difficulties score 0-40. Higher indicating more problems. | after 10 weeks of intervention |
| Strength and Difficulties Questionnaire (SDQ) | Parent questionnaire on the strength and difficulties of the child. Total difficulties score 0-40. Higher indicating more problems. | 24 week follow-up |
| Brief Symptom Inventory | Parent questionnaire on their own symptoms. Score range 0-212. Higher indicating more problems. | baseline |
| Attention Deficit Hyperactivity Disorder- Rating Scale (ADHD-RS) | Parent questionnaire on child ADHD symptoms. Score range: 1-78. Higher indicates more problems. | after 10 weeks of intervention |
| Attention Deficit Hyperactivity Disorder- Rating Scale (ADHD-RS) | Parent questionnaire on child ADHD symptoms. Score range: 1-78. Higher indicates more problems. | 24 weeks follow up |
| Parental Stress Scale | Parent rating scale on their stress level. Score range: 18-90. Higher scores indicate more stress. | after 10 weeks of intervention |
| Parental Stress Scale | Parent rating scale on their stress level. Score range: 18-90. Higher scores indicate more stress. | 24 week follow up |