Children in foster care with symptoms of reactive attachment disorder: feasibility randomised controlled trial of a modified video-feedback parenting intervention.

Journal: BJPsych open

Volume: 8

Issue: 4

Year of Publication: 

Affiliated Institutions:  Division of Psychology and Language Sciences, University College London, UK; and Anna Freud National Centre for Children and Families, UK. Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. School of Psychosocial Health, North-West University, South Africa. Division of Psychology and Language Sciences, University College London, UK. Faculty of Education, University of Cambridge, UK. Hull York Medical School, University of York, UK. South London and Maudsley NHS Trust, UK; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. Research and Development Unit, Tavistock and Portman NHS Foundation Trust, UK. Department of Social Policy and Intervention, University of Oxford, UK. Great Ormond Street Hospital for Children, UK; and Division of Psychology and Language Sciences, University College London, UK. Division of Psychology and Language Sciences, University College London, UK; Anna Freud National Centre for Children and Families, UK; and Centre for Family Research, University of Cambridge, UK.

Abstract summary 

Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD.To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility of conducting a randomised controlled trial (RCT) of the modified intervention.The intervention was modified with expert input and tested on a case series. A feasibility and pilot RCT compared the new intervention with usual care. Foster carers and children in their care aged ≤6 years were recruited across nine local authorities, with 1:1 allocation and blind post-treatment assessments. The modified intervention was delivered in-home by trained mental health professionals over 4-6 months. Children were assessed for RAD symptoms, attachment quality and emotional/behavioural difficulties, and foster carers were assessed for sensitivity and stress.Minimal changes to the intervention programme were necessary, and focused on improving its suitability for the UK foster care context. Recruitment was challenging, and remained below target despite modifications to the protocol and the inclusion of additional sites. Thirty families were recruited to the RCT; 15 were allocated to each group. Most other feasibility outcomes were favourable, particularly high numbers of data and treatment completeness. The revised intervention was positively received by practitioners and foster carers.A large-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended.

Authors & Co-authors:  Oliveira Paula P Barge Lydia L Stevens Eloise E Byford Sarah S Shearer James J Spies Ruan R Comyn Julie J Langley Kirsty K Ramchandani Paul P Wright Barry B Woolgar Matt M Kennedy Eilis E Scott Stephen S Barlow Jane J Glaser Danya D Senior Rob R Fonagy Peter P Fearon Pasco P

Study Outcome 

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Statistics
Citations :  Ford T, Vostanis P, Meltzer H, Goodman R. Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households. Br J Psychiatry 2007; 190(4): 319–25.
Authors :  18
Identifiers
Doi : e134
SSN : 2056-4724
Study Population
Male,Female
Mesh Terms
Other Terms
Attachment disorder;feasibility;foster care;parenting intervention;randomised controlled trial
Study Design
Case Study,Cross Sectional Study
Study Approach
Country of Study
Publication Country
England