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Background: Most young children (0–3 years) attend formal childcare in Denmark, many of them fulltime. Yet recent reports of the quality of Danish childcare centers have shown that in more than one-third of nurseries, the interactions between caregivers and young children (0–3 years) are of “insufficient” quality, which constitutes a risk for affected children’s well-being and development. Effective interventions to improve childcare providers’ interactive skills are necessary. Methods: In this randomized controlled trial, we test the effectiveness of the Caregiver Interaction Profile training, which focuses on improving six core interactive skills: sensitive responsiveness, respecting children’s autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions. We will recruit N = 200 childcare providers from nursery groups in Copenhagen (n = 100 training group, n = 100 waiting-list control group). Our primary outcomes are childcare providers’ six interactive skills named above, observed from video-recorded interactions in the nursery groups. The secondary goal of our study is to test whether the training boosts children’s social-emotional and linguistic development. To this end we aim to recruit N ≈ 500 children from participating childcare providers’ nursery groups (n ≈ 250 training group, n ≈ 250 waiting-list control group). We measure social-emotional and linguistic development with various standardized questionnaires, filled out by parents and childcare providers. Discussion: If the training is effective at improving childcare providers’ interactive skills, then this will be an important foundation for implementation efforts, such as offering the training as part of the educational program of childcare providers. Future research should also evaluate whether the Caregiver Interaction Profile training is effective for childcare providers of older children (3–5 years) in Danish kindergartens. Tri

The quality of parent-child interaction has consistently been associated with child psychosocial outcomes. Postnatal depression (PND) and anxiety (PNA) can have an adverse effect on the parent-child interaction. The Coding Interactive Behaviour (CIB) measure has frequently been used to assess parent-infant interaction quality; however, few have investigated the construct validity. The purpose of this study is to: (1) compare two theoretical models and one data-driven model for best fit and to test the best fitting one for measurement invariance among mothers with and without PND, and (2) compare effects of PND and PNA on the mother-infant interactions. The sample consisted of mothers with PND (n = 236) and a subclinical sample of mothers with elevated symptoms of PND but did not meet criteria for a diagnosis (n = 183) and their infants (aged ≤ 6 months). PND was assessed with a diagnostic interview and PNA using a self-report measure. Confirmatory factor analyses showed that the data-driven model, consisting of the composites ‘Maternal Sensitivity’, ‘Child Engagement’, ‘Maternal Social Withdrawal’, and ‘Maternal Controlling Behaviour’, reached the best fit and showed measurement invariance with regard to PND. Factorial ANOVAs showed no effects of PND and PNA on the composites. The study is the first to investigate and find measurement invariance in the CIB, providing evidence of construct validity. The importance of investigating the factor structure of an instrument liable to change due to contextual factors is discussed., The quality of parent-child interaction has consistently been associated with child psychosocial outcomes. Postnatal depression (PND) and anxiety (PNA) can have an adverse effect on the parent-child interaction. The Coding Interactive Behaviour (CIB) measure has frequently been used to assess parent-infant interaction quality; however, few have investigated the construct validity. The purpose of this study is to: (1) compare two theoretical models and one data-driven model for best fit and to test the best fitting one for measurement invariance among mothers with and without PND, and (2) compare effects of PND and PNA on the mother-infant interactions. The sample consisted of mothers with PND (n = 236) and a subclinical sample of mothers with elevated symptoms of PND but did not meet criteria for a diagnosis (n = 183) and their infants (aged ≤ 6 months). PND was assessed with a diagnostic interview and PNA using a self-report measure. Confirmatory factor analyses showed that the data-driven model, consisting of the composites ‘Maternal Sensitivity’, ‘Child Engagement’, ‘Maternal Social Withdrawal’, and ‘Maternal Controlling Behaviour’, reached the best fit and showed measurement invariance with regard to PND. Factorial ANOVAs showed no effects of PND and PNA on the composites. The study is the first to investigate and find measurement invariance in the CIB, providing evidence of construct validity. The importance of investigating the factor structure of an instrument liable to change due to contextual factors is discussed.

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.

There is broad evidence which suggests that people who have been subjected to interpersonal trauma often experience shame. The aim of this study is to shed light on the paradoxical shame felt by victims of abuse. More specifically, the study explores trauma-related shame in the context of child sexual abuse (CSA), with a focus on what characterises this type of shame, how it is experienced and how it affects the lives of survivors of CSA. Additionally, some mechanisms for the development and maintenance of trauma-related shame are proposed. Semi-structured interviews were conducted with two adult survivors of CSA. The interviews were first analysed through an interpretative phenomenological analysis. Secondly, a deductive, theory-driven analysis was conducted, where theories on trauma and shame, concepts from phenomenology and embodiment literature, in addition to psychoanalytic conceptualizations of psychic trauma, were applied to the data. Central aspects of trauma-related shame were found to include feelings of being different, unlovable, and of being the carrier of something unbearable that cannot be revealed. Inherent in shame is the impulse to conceal the self, both physically and emotionally. In the participants’ experience this urge seems to have been generalized to an extent where it is difficult to share any personal thoughts, feelings, or events. Social isolation can in turn exacerbate and confirm shame in a self-preserving circle. Trauma-related shame can thus be seen as a hindrance to the disclosure of abuse, the treatment of trauma, as well as to social support. Shame is difficult to regulate since it entails devaluations of the global self. Therefore, it can be regulated by strategies involving detachment from one’s own body, feelings, or thoughts. I argue that mental, emotional, and social avoidance behaviour can be understood as being aimed towards avoiding a deep, traumatic shame. Trauma-related shame in the context of CSA is in this

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. This article is divided into two parts. In the first part, 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., La teoría y la investigación sobre el apego se utilizan en muchos contextos aplicados, incluidos los juzgados de familia, pero hay malentendidos muy extendidos y que a veces dan lugar a aplicaciones erróneas. El objetivo de este documento de consenso es, por lo tanto, mejorar la comprensión, contrarrestar la desinformación y dirigir el uso de la teoría del apego por parte de los juzgados de familia en la dirección de un apoyo basado en la evidencia, especialmente en lo que respecta a la protección de niñas y niños y las decisiones sobre su custodia. El artículo se divide en dos partes. En la primera abordamos los problemas relacionados con el uso de la teoría y la investigación sobre apego en los juzgados de familia, analizando las causas de tales problemas. Para ello examinamos las aplicaciones de la teoría del apego en los juzgados de familia en el marco del concepto de interés superior de niños y niñas, analizamos los malentendidos relacionados con la teoría del apego e identificamos los factores que han obstaculizado su adecuada aplicación. En la segunda parte ofrecemos recomendaciones para la aplicación de la teoría y la investigación sobre apego. Para ello establecemos tres principios del apego: la necesidad de niñas y niños de cuidadoras y cuidadores habituales que no maltraten, el valor de la continuidad de cuidados de calidad suficientemente buena y los beneficios de las redes de relaciones de apego. También analizamos la idoneidad de las evaluaciones de los estilos de apego y del comportamiento de los cuidadores para fundamentar la toma de decisiones de los juzgados de familia. Llegamos a la conclusión de que las evaluaciones de quienes cuidan deberían ocupar un lugar central. Aunque no hay consenso entre nosotros sobre el uso de las evaluaciones del estilo de apego para fundamentar las decisiones sobre custodia y protección infantil, dichas evaluaciones son actualmente las más adecuadas para orientar y dirigir las intervenciones de apoyo. Por último, prop

Attachment concepts are used in diverging ways, which has caused confusion in communication among researchers, among practitioners, and between researchers and practitioners, and hinders their potential for collaboration. In this essay we explore how attachment concepts may vary in meaning across six different domains: popular discourses, developmental science, social psychological science, psychiatric diagnosis, psychotherapy, and child welfare practice. We attempt to typify these forms of attachment discourse by highlighting points of convergence, divergence, and relay between the different domains. Our general conclusions are that diversity in the use of attachment concepts across different domains of application has been largely unrecognised, and that recognition of these differences would reduce confusion, help identify sites where infrastructure needs to be developed to support coordination, and strengthen opportunities for collaboration to mutual benefit. We suggest that academic attachment discourse would benefit from clarification of core terminology, including: “attachment”, “internal working model”, “trauma”, and “dysregulation”.

Worldwide, millions of children live in institutions, which runs counter to both the UN-recognised right of children to be raised in a family environment, and the findings of our accompanying systematic review of the physical, neurobiological, psychological, and mental health costs of institutionalisation and the benefits of deinstitutionalisation of child welfare systems. In this part of the Commission, international experts in reforming care for children identified evidence-based policy recommendations to promote family-based alternatives to institutionalisation. Family-based care refers to caregiving by extended family or foster, kafalah (the practice of guardianship of orphaned children in Islam), or adoptive family, preferably in close physical proximity to the biological family to facilitate the continued contact of children with important individuals in their life when this is in their best interest. 14 key recommendations are addressed to multinational agencies, national governments, local authorities, and institutions. These recommendations prioritise the role of families in the lives of children to prevent child separation and to strengthen families, to protect children without parental care by providing high-quality family-based alternatives, and to strengthen systems for the protection and care of separated children. Momentum for a shift from institutional to family-based care is growing internationally—our recommendations provide a template for further action and criteria against which progress can be assessed.

Millions of children worldwide are brought up in institutional care settings rather than in families. These institutions vary greatly both in terms of their organi­sational principles and structure, and in terms of the quality of care provided. Although institutions are universally recognised as providing suboptimal care­giving environments, consensus is still needed on how to interpret the evidence relating to the size, range, and persistence of the effect of institutional care on the development and wellbeing of children. This absence of consensus has led to disagreement as to whether policy should focus on eliminating, transforming, or improving institutions.We reviewed the literature on child institutionalisation and deinstitutionalisation from a global perspective. This review included a survey of historical and cultural trends and estimates of current numbers of children in institutional care, a systematic review and meta­analysis of developmental sequelae, and a largely qualitative review of factors found to predict individual variations in such outcomes. The numbers of children in institutional care have varied enormously over the years and from region to region, driven by a range of political, cultural, and socioeconomic factors. Millions of children worldwide are known to be housed in institutions.1 We found strong negative associations between institutional care and children’s development, especially in relation to physical growth, cognition, and attention. Significant but smaller associations were found between institutionalisation and socioemotional development and mental health. Leaving institutions for foster or family care is associated with significant recovery for some developmental outcomes (eg, growth and cognition) but not for others (eg, attention). The length of time in institutions was associated with increased risk of adverse sequelae and diminished chance of recovery. However, we could not disentangle the association between developmental o

Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that disorganized attachment (2) reliably indicates child maltreatment, (3) is a strong predictor of pathology, and (4) represents a fixed or static trait of the child, impervious to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the difference between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attachment theory for supportive work with families and for the development and evaluation of evidence-based caregiving interventions.