Conference Agenda

Background and aims

Allied Health and specialist teachers in Early Childhood Intervention (ECI) support the development, wellbeing, and participation of children with a disability or developmental delay. Although the Australian National Best Practice Guidelines for ECI emphasise the importance of safe and secure parent-child relationships, many ECI professionals lack the training or confidence to support the development of secure parent-child relationships. This study aimed to identify how ECI professionals can most effectively promote attachment security within the everyday context of best practice in ECI.

Methods

Mixed methods design was used to address the overarching question: How can ECI professionals improve the attachment security of children with a disability or developmental delay? Methods included a systematic review of attachment patterns and intervention approaches, a survey of ECI professionals (n=49), and in-depth interviews with parents and professionals (n=21). Data were analysed using Constructivist Grounded Theory.

Results

Children with a disability or developmental delay were significantly less likely to develop a secure attachment (42% compared to 62% in the general population) and nearly twice as likely to develop a disorganised attachment (29% compared to 15%). Although evidence for attachment-focused intervention in this population was limited, several promising approaches emerged such as coaching and video feedback. Based on the integrated data, a framework for attachment-focused ECI was developed.

Conclusions and implications

Attachment security is foundational to developmental, relational, and behavioural outcomes for children with disability or developmental delay. The findings highlight the risks inherent in ECI overlooking parent-child relationship support. The study identifies practical, discipline-spanning strategies ECI professionals can implement to enhance the likelihood of secure parent-child relationships such as reducing parental stress, talking about attachment, and supporting co-regulation.

Background

Attachment theory highlights early caregiver–child relationships as central to emotional security, exploration, and holistic development. In children with Intellectual and Developmental Disabilities (IDDs), attachment may be expressed in non-normative ways, suggesting a broader understanding of how proximity-seeking and reciprocity are displayed. Existing literature has focused on standardized attachment classifications, intervention outcomes, or the impact of diagnosis. However, families’ own experiences of bonding and affective relationships remain underrepresented.

Method

This scoping review follows Arksey & O’Malley’s framework and synthesizes qualitative and mixed-method studies examining how families perceive attachment relationships with young children (0-6 years) with IDDs. Particular attention is given to studies foregrounding caregivers’ voices. The review also maps key characteristics and methods of the included studies.

Results

Caregivers describe the formation of emotional bonds as a dynamic and emotionally complex process. Bonding is rarely immediate or linear, but develops over time through daily interaction, adaptation, and growing understanding of the child. Caregiver narratives highlight the construction of parental identity, the assumption of expanded caregiving roles, and fluctuating emotional experiences. The caregiver–child bond is described as strong but qualitatively different, characterized by physical closeness, constant availability, and affective effort, with less reciprocal or verbally mediated interaction.

Attachment relationships are shaped by a complex interplay of child-related, caregiver-related, diagnostic, contextual, and temporal factors. Child characteristics influence how attachment behaviors are expressed and interpreted, while caregiver emotional availability, sensitivity, and relational capacities are central. Diagnostic processes, social support, and changing demands over time further mediate attachment experiences.

Conclusions

Family narratives show that attachment in the context of disability is not diminished but often takes different forms. It is not determined by a single factor, but by interactions across individual, relational, and systemic levels. These findings support a more inclusive understanding of attachment and highlight the importance of family-centered practice.

Children in foster care are at elevated risk of emotional and behavioral difficulties, often linked to early adversity and disrupted attachment relationships. Foster parents play a central role in supporting recovery and adjustment, yet many report feeling insufficiently equipped to manage the complex needs of children in their care. Mentalization-Based Therapy (MBT) for foster families aims to strengthen caregivers’ reflective functioning, thereby improving parent–child relationships and children’s psychosocial adjustment. Evidence for MBT in foster care remains limited, particularly in Scandinavian welfare contexts.

This study reports on a pragmatic, cluster-randomized controlled trial of MBT for foster families conducted across ten Danish municipalities. Forty-six foster care consultants were randomized to MBT training or usual care and recruited foster families caring for a child aged 4–17 years with emotional or behavioral difficulties. In total, 106 foster families participated (71 MBT, 35 usual care). MBT was delivered as a short-term intervention of up to 12 sessions over approximately 3–4 months. Outcomes were assessed at baseline, post-intervention, and six-month follow-up.

The primary outcome was child psychosocial adjustment measured by foster parent report on the Child Behavior Checklist (CBCL). Secondary outcomes included child well-being, parental stress, parental mental health, parental reflective functioning, parent–child relationship quality, and placement stability. Analyses follow an intention-to-treat approach and account for clustering at the consultant level.

Post-intervention and follow-up data collection and analyses are currently being finalized. At the conference, we will present comparative results for MBT versus usual care on primary and secondary outcomes.

This trial represents the first experimental evaluation of an attachment- and mentalization-based family intervention for foster families in a Scandinavian context. Findings will contribute critical evidence on whether strengthening caregiver mentalization can improve outcomes for foster children and inform future intervention and policy development in out-of-home care.

Background

For young children who spend a significant amount of time in daycare, interactions with childcare providers (CPs) are an important context of early development. CPs are part of young children’s attachment network. In this randomized controlled trial we test the effectiveness of the Caregiver Interaction Profile (CIP) training, a video-feedback intervention to enhance six interactive skills in CPs. These interactive skills are: sensitive responsiveness, respect for autonomy, structuring and limit-setting, verbal communication, developmental stimulation, and fostering positive peer interactions. We tested the effects of the CIP training on CPs’ interactive skills and on socio-emotional and language development of 0-3 year-old children in the nursery groups.

Methods

CPs (N=248) from nursery groups in Copenhagen were randomly assigned to the CIP training or a waiting-list control group. Randomization was done by an external researcher at the level of the nursery group with a 1:1 ratio. To assess CPs´ interactive skills, four 10-minute daily interactions (play, mealtime, diaper change, and transition) were video-recorded at baseline and again two weeks after completion of the CIP-training. Recordings were coded using the CIP scales by coders blinded to group assignment and timepoint. To assess children’s development, CPs and parents filled out the Ages and Stages Questionnaire: Social-Emotional, Strengths and Difficulties Questionnaire, Child Behavior Checklist, and the brief Communicative Development Inventories for childcare.

Results

Intention-to-treat and treatment-as-given analyses, controlling for CPs’ educational level, showed that CPs in the CIP group demonstrated significantly greater improvements than the control group in sensitive responsiveness, respect for autonomy, verbal communication, developmental stimulation, and fostering positive peer interactions. Effects were not moderated by sick leave or staff turnover. Analyses on child outcomes are underway.

Conclusions

Our study adds to the evidence base that the CIP training is effective in improving interactive skills in CPs that are important for child development.