2021

Craig, S. G., Sierra Hernandez, C., Moretti, M. M, & Pepler, D. J. (2021). The mediational effect of affect dysregulation on the association between attachment to parents and oppositional defiant disorder symptoms in adolescents. Child Psychiatry and Human Development, 52, 818-828. Click here

Abstract: Oppositional defant disorder (ODD) is a childhood disorder, commonly occurring in early school aged children with some symptoms becoming normative in adolescence (e.g., irritability, disagreeing). Afect dysregulation is a risk factor in the development of ODD. Afect regulation is nurtured within parent–child relationships, thus disruptions to attachment may derail children’s capacity to develop adaptive afect regulation, increasing the risk for ODD. Using a high-risk sample of adolescents, we investigated the association between attachment anxiety and attachment avoidance with ODD through afect dysregulation. Attachment anxiety, but not avoidance, was associated with afect dysregulation and ODD. Afect dysregulation was found to fully mediate the relationship between attachment anxiety and ODD concurrently and prospectively. Similar fndings have been demonstrated among children; results show that attachment anxiety, and its efects on afect dysregulation, are associated with ODD symptoms well into adolescence.
Principal Investigator: Dr. M. Moretti (PI) and Dr. D. Pepler (Co-I)

Funding: Funding This research is funded by the Canadian Institutes of Health Research (CIHR), Institute of Gender and Health (IGH) through a New Emerging Team Grant (Grant No. #54020) and Operating Grant (Grant No. #84567) awarded to Dr. M. Moretti (PI) and Dr. D. Pepler (Co-I); Dr. Marlene Moretti is also funded by CIHR Team Grant (Grant No. #115617) and a Canadian Research Chair (Tier 1) in Youth Clinical Psychological Science; Dr. Stephanie Craig is funded by CIHR fellowship.

Goulter, N., & Moretti, M. M. (2021). Network structure of callous‑unemotional traits and conduct disorder symptoms among at‑risk youth: Multi‑informant reports and gender differences. Research on Child and Adolescent Psychopathology, 49(9), 1179-1196. Click here

Abstract: Network analytic techniques examine how items used to measure underlying constructs are related to one another and identify core characteristics. While many studies have examined the covariance of callous-unemotional (CU) traits or features and conduct disorder (CD) symptoms, the inter-item relations of these constructs and the core characteristics of the CU construct are unclear. The present study aimed to examine the network connectivity of, and between, CU features and CD symptoms. We also examined both parent-reports and youth self-reports and gender diferences. CU features and CD symptoms were rated by parents (n=814; 74% mothers; age 23–73, M age=43.86, SD=8.13) and their child (n=608; 57% female; age 7–19, M age=13.98, SD=2.36). Network plots depicted greater connectivity (i.e., density and weights) for CU features relative to CD symptoms across both informants. However, youth-reported CU features and CD symptoms were less densely connected than parent-reports. Items commonly comprising the callousness subscale were more central and linked the two constructs together, relative to uncaring items, across informant and gender. Gender related efects indicated lower centrality for male versus female youth, and this fnding was particularly evident in youth-reports. Our fndings highlight relations between CU features and CD symptoms, and point to the importance of callousness items in conceptualizations of CU features among high-risk youth from both the perspective of the parent and child. We also inform understanding of gender diferences in CU features for which the literature is currently limited.

Funding: This research was supported by grants from the Canadian Institutes of Health Research (Operating Grant [232570]; Team Grant [251560])

Forslund, T., Granqvist, P., van IJzendoorn, M. H., Sagi-Schwartz, A., Glaser, D., Steele, M., Hammarlund, M., Schuengel, C., Bakermans-Kranenburg, M. J., Steele, H., Shaver, P. R., Lux, U., Simmonds, J., Jacobvitz, D., Groh, A. M., Bernard, K., Cyr, C., Hazen, N. L., Foster, S., … Duschinsky, R. (2021). Attachment goes to court: child protection and custody issues. Attachment & Human Development, 1–52. Click Here

Abstract: Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child’s need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

Funding: This work was supported by grants from the Swedish Research Council (Grant 2017-03315) and the Swedish research Council for Health, Working Life, and Welfare (Grant 2017-01182) awarded to Pehr Granqvist and Tommie Forslund, and by a Medical Humanities Investigator Award from the Wellcome Trust (Grant WT103343MA) awarded to Robbie Duschinsky.

Osman, F., Vixner, L., Flacking, R., Klingberg-Allvin, M., Schön, U.-K., & Salari, R. (2021). Impact of a culturally tailored parenting programme on the mental health of Somali parents and children living in Sweden: a longitudinal cohort study. BMJ Open, 11(8), e045067–e045067. https://doi.org/10.1136/bmjopen-2020-045067 Click here

Abstract: Objectives This study aimed to evaluate the long-term impact (3-year follow-up) of a culturally tailored parenting support programme (Ladnaan) on the mental health of Somali-born parents and their children living in Sweden. Methods In this longitudinal cohort study, Somali-born parents with children aged 11–16 were followed up 3 years after they had participated in the Ladnaan intervention. The Ladnaan intervention comprises two main components: societal information and the Connect parenting programme delivered using a culturally sensitive approach. It consists of 12 weekly group-based sessions each lasting 1–2 hours. The primary outcome was improved mental health in children, as measured by the Child Behaviour Checklist (CBCL). The secondary outcome was improved mental health in parents, as measured by the General Health Questionnaire-12. Data were collected from the parent’s perspective. Results Of the 60 parents who were originally offered the intervention, 51 were included in this long-term follow-up. The one-way repeated measures (baseline to the 3-year follow-up) analysis of variance for the CBCL confirmed maintenance of all the treatment gains for children: total problem scores (95% CI 11.49 to 18.00, d=1.57), and externalising problems (95% CI 2.48 to 5.83, d=0.86). Similar results were observed for the parents’ mental health (95% CI 0.40 to 3.11, d=0.46). Conclusion Positive changes in the mental health of Somali-born parents and their children were maintained 3 years after they had participated in a parenting support programme that was culturally tailored and specifically designed to address their needs. Our findings highlight the long-term potential benefits of these programmes in tackling mental health issues in immigrant families. Trial registration number NCT02114593 .

Funding: Kamprad Foundation.  Grant 2017:0069.

Barone, L., Carone, N., Costantino, A., Genschow, J., Merelli, S., Milone, A., Polidori, L., Ruglioni, L., & Moretti, M. M. (2021). Effect of a parenting intervention on decreasing adolescents’ behavioral problems via reduction in attachment insecurity: A longitudinal, multicenter, randomized controlled trial. Journal of Adolescence, 91, 82–96. Click here

Abstract:
Introduction: Secure attachment in adolescence, related to caregiving quality, is a robust predictor of positive behavioral adjustment in early adulthood and beyond. Nevertheless, few attempts have been made to develop treatments to promote parent-adolescent attachment security.
Methods: Using a longitudinal, multicenter, randomized controlled trial design, two questionnaire-based studies were run in Italy (Study 1: n = 100 mothers of adolescents, 60% boys, Mage = 14.89, SD = 1.58; Study 2: n = 40 mothers and 40 adolescents, 60% boys, Mage = 14.90, SD = 1.91) to test the effectiveness of an attachment-based parenting intervention (i.e., Connect) in reducing adolescents' behavioral problems and attachment insecurity 2 weeks post-intervention (t2) and at a 4-month follow-up (t3). It was further investigated whether a decrease in avoidant and anxious attachment at t2 would account for changes in externalizing and internalizing problems, respectively, at t3. All adolescents belonged to two-parent intact families.
Results: Mothers who completed Connect reported significantly fewer adolescent behavioral problems and lower adolescent attachment insecurity, compared to mothers in the waitlist group, at both t2 and t3 (Study 1). These findings were confirmed in a second subsample (Study 2), considering both mothers' and adolescents' reports. Controlling for pre-intervention behavioral problems, reductions in internalizing and externalizing problems were observed in both studies at t3 via a decrease in anxious and avoidant attachment, respectively, at t2.
Conclusions: The findings point to the malleability of attachment security in adolescence and highlight the importance of targeting parenting quality to promote adolescent behavioral

Funding: The Canadian Institutes of Health Research (CIHR, grant no. TVG-115617)

Dangaltcheva, A., Booth, C., Moretti, M. M. (2021). Transforming Connections: A trauma-informed and attachment-based program to promote sensitive parenting of trans and gender nonconforming youth. Frontiers in Psychology. Click here

Abstract: Gender non-conforming and trans youth experience high rates of bullying and victimization, placing them at risk for serious mental health challenges. Parent support is one of the most significant protective factors in this population, and yet few programs are specifically developed to promote parenting sensitivity, understanding, and acceptance. Connect, a trauma-informed and attachment-based group program for caregivers of at-risk adolescents, has been shown to reduce parent stress and depressed mood, increase parents' sense of efficacy and satisfaction, and reduce parent-teen conflict. Teens benefit from increased attachment security and improved mental health and well-being. Treatment effects have been documented to continue for up to 2 years post-treatment. This paper describes the adaptation of the Connect program to create a new program, Transforming Connections, for caregivers of transgender and gender non-conforming youth. Participants in the first three groups were 20 parents of 16 gender non-conforming youth (ages 12–18). Common themes in group discussions related to gender included: coming out, connecting with peers, affirming pronouns/names, medical transition, parental reactions (e.g., confusion, isolation, grief, acceptance), and concerns about safety and mental health. All parents completed the full program, attending on average 9 of 10 sessions. Caregivers reported feeling respected, safe, and welcomed in the program and indicated that learning about attachment enhanced their understanding of their teen and their gender journey as well as themselves as a parent. Additionally, all parents reported applying the ideas discussed in the group frequently (60%) or somewhat frequently (40%). The majority indicated that their relationship with their teen had improved somewhat (65%) or a great deal (20%). Findings provide positive preliminary evidence of the fit and value of Transforming Connections for these families.

Funding: The Canadian Institute of Health Research (CIHR) Operating Grant (#232570), CIHR IGH Team Grant (#251560), and Canada Research Chair (Tier 1) in Youth Clinical Psychological Science awarded to MM.

Pasalich, D. S., Moretti, M. M., Hassall, A., Curcio, A. (2021). Pilot randomized controlled trial of an attachment- and trauma-focused intervention for kinship caregivers. Journal of Clinical Child & Adolescent Psychology. Click here

Abstract: Background:Kinship care placements are increasing in many Western countries, however families in kinship care are underserved partly due to the lack of evidence-based interventions addressing their unique needs.
Objective: We conducted a pilot randomized controlled trial (RCT) to examine research feasibility and the acceptability, fidelity, and preliminary outcomes of an attachment- and trauma-focused intervention for kinship caregivers in Australia.
Participants and setting: Participants included 26 kinship caregivers (Mage = 55.00 years; 54% grandparents) with youth (Mage = 10.58 years; 38% female), and 19 practitioners from child protection, out-of-home care and other services.
Method: Kinship caregivers were randomized to Connect for Kinship Parents (Connect-KP) or care-as-usual (CAU), and completed assessments at baseline, post-intervention, and 6-month follow-up. Placement changes were evaluated at 6-month follow-up. A subset of practitioners received both training and supervision in implementing Connect-KP, and their videorecorded sessions were coded for fidelity.
Results: Practitioners rated the training highly and demonstrated excellent fidelity to program content and process. Results supported the research feasibility and all kinship caregivers reported high levels of program satisfaction and had very high attendance and completion rates. Direction of effects favored Connect-KP vs. CAU for all nine caregiver and youth outcomes, with the largest effects observed for significant reductions in caregiver strain, caregiver psychological aggression, and youth affect suppression following intervention. At 6-month follow-up, more youth from CAU (15%) vs. Connect-KP (0%) experienced an unplanned placement change.
Conclusions: Our findings show promise of Connect-KP as a potentially effective intervention that can be successfully implemented in child welfare services, and provide impetus for a larger-scale RCT.

Pasalich, D.S., Craig, S.G., Goulter, N., O’Donnell, K.Al, Sierra Hernandez, C., & Moretti, M. M. (2021). Patterns and predictors of different youth responses to attachment-based parent intervention. Journal of Clinical Child and Adolescent Psychology. Click here

Abstract: Objective: Few studies have evaluated attachment-based parent interventions for pre-teens and teens, and in particular, differential adolescent trajectories of response. This study examined distinct patterns, and multi-level predictors, of intervention response among youth with serious behavioral and mental health problems whose parents participated in Connect, an attachment- and trauma-informed parent program. Method: Participants included 682 parents (Mage = 42.83, 86% mothers) and 487 youth (Mage = 13.95, 53% female, 28.1% ethnic minority) enrolled in a community-based evaluation of Connect. Parents and youth reported on youth externalizing and internalizing problems (EXT and INT) at six time points from baseline through 18-months post-intervention. Demographic and youth and family level predictors were assessed at baseline. Results: Growth mixture modeling revealed three distinct trajectory classes in both the parent and youth models based on different patterns of co-occurring EXT and INT and degree of improvement over time. Youth with severe EXT showed the largest and fastest improvement, and, interestingly, were characterized by higher callous-unemotional traits and risk-taking at program entry. Youth with comorbid EXT/INT demonstrated a partial or moderate response to intervention in the parent and youth model, respectively, and were characterized by more attachment anxiety at baseline. Most youth showed relatively moderate/low levels of EXT/INT at baseline which gradually improved. Caregiver strain also predicted trajectory classes. Conclusions: These results have significance for tailoring and personalizing interventions for high-risk youth and provide new understanding regarding the profiles of subgroups of youth who show different responses to an attachment-based parent intervention.

Funding: Canadian Institutes of Health Research Team Grant (No. 251560). Additional support for this study was provided by an Australian Research Council Discovery Early Career Researcher Award (No. DE170100078) to Dave S. Pasalich, and a Canada Research Chair (Tier 1) award to Marlene M. Moretti.

Ranahan, P., Pascuzzo, K. & Moretti, M. M. (2021). Storying security with parents and teens: From vicious circles to strengthened relationships. Relational Child & Youth Care Practice, 34, 1, 123-130. Click here