Oct 26, 2008

Dyadic Developmental Psychotherapy: An evidence based and effective treatment

Dyadic Developmental Psychotherapy is an effective and evidence-based treatment for trauma and attachment disorders. There have been a few empirical follow-up studies published in professional peer-reviewed publications following a group of families that received DDP and a group who received other forms of treatment. These studies demonstrated that the children treated with DDP had clinically and statistically significant reductions in various scales of the Child Behavior Checklist (Achenbach) while those who received other treatments (play therapy, residential treatment, group therapy, family therapy, etc) from other providers showed no changes and, after four years, actually showed clinically and statistically significant deteriorations in their behavior.

Craven & Lee (2006) determined that DDP is a supported and acceptable treatment (category 3 in a sixlevel system). However, their review only included results from a partial preliminary presentation of an ongoing follow-up study, which was subsequently completed and published in 2006. This initial study compared the results DDP with other forms of treatment, ‘usual care’, 1 year after treatment ended. A second study extended these results out to 4 years after treatment ended. Based on the Craven & Lee classifications (Saunders et al. 2004), inclusion of
those studies would have resulted in DDP being classified as an evidence-based category 2, ‘Supported and probably efficacious’. Other than lacking two randomized controlled studies, DDP would have be classified as a category 1, "Well supported efficacious treatment," the highest level.

The interested reader may want to look at the following references for further details:

Becker-Weidman, A., (2006)“Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy,” Child and Adolescent Social Work Journal. Vol. 23 #2, April 2006, pp 147-171.

Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” http://www.center4familydevelop.com/research.pdf

Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Adolescent Social Work, 13, pp.329-337.

Becker-Weidman, A., & Shell, D., (Eds.), (2008) Creating Capacity for Attachment: Dyadic Developmental Psychotherapy in the Treatment of Trauma-Attachment Disorders. Arthur Becker-Weidman, Ph.D., & Debra Shell, (Eds.) Woods N Barnes publishing, Oklahoma City, OK, & Center for Family Development, Williamsville, NY, Second Printing: 2008.

Craven, P. & Lee, R. (2006) Therapeutic interventions for foster children: a systematic research synthesis. Research on Social Work Practice, 16, 287–304.

Saunders, B., Berliner, L. & Hanson, R. (2004) Child physical and sexual abuse: guidelines for treatment. Available at: http://academicdepartments.musc.edu/ncvc/resources_prof/

9 comments:

stressmom said...

It is a little frightening that you state that services such as play therapy and residential treatment show no greater long term benefits than they do. That concerns me because it seems that many of the programs that I read about are employing these methods. Is that just because it is the model that so many are familiar with for treatment and are hesitant to change?

Arthur Becker-Weidman, PhD said...

What our empirical studies found was that "usual care," (such as play therapy, etc) produced no measurable changes on the Child Behavior Checklist (Ackenbach) and that four years later, those children actually scored statistically and significantly worse; even though they continued to receive treatment from other providers at other centers, but did not receive Dyadic Developmental Psychotherapy. What we found, was that those families that received Dyadic Developmental Psychotherapy moved from the clinical range to the normal range ans stayed there four years later.

My experience training professionals, residential treatment centers, departments of child welfare, schools, etc. is that when they learn about the model, they are quite comfortable using this evidence-based and effective model of treatment. For more details, you may want to look at the book I co-edited, Creating Capacity for Attachment or at the following article:
Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Adolescent Social Work, 13, pp.329-337.
regards

LAFernandez said...

I am a psychotherapist who treats adoptive and foster children. I was reading one of your articles that stated DDP addresses attachment in 2 phases/areas : infant (need) and the second year (shame). Can you please tell me more about the 2nd year with shame, and where I can read more about that? Thanks!!!

I also have a biological child who is 2 and had numerous medical traumas in the first 6 mos. I am desperately seeking some information to help him as well. We used attachment parenting especially in the first year and have used Love and Logic during the last 2 years. He is almost 3 now and can be aggressive at times toward his baby sister (9 mos) and is extremely anxious. He has rarely slept thru the night. He has had difficulties with night terrors at times. If he becomes really dysregulated, he won't accept comfort from us, and that really concerns me. As much as I feel like I know, I'm at a loss.
Thanks for any info you can provide.

LAFernandez said...

I am a psychotherapist who treats adoptive and foster children as well as biological children who have been traumatized. I am interested in something I read in one of your articles about DDP addressing attachment on two levels: infant (need) and the second year (shame). Would you give me more information about that and where I can read more about that idea?

Also, I have a 2 year old (3 in a couple of months) who had numerous medical traumas in the first 6 mos. We used attachment parenting and Love and Logic since he was 12 mos. As much as I feel like I know about all this, I am at a loss with him. I am looking for some information and resources to help him heal. I live in Raleigh, NC. (I attended the ATTACh conference in Charlotte in Sept) Could you point me in a direction for him as well? thanks so much!

Arthur Becker-Weidman, PhD said...

Dear LAFernandez,

The idea about the two stages (see E. Erikson) Trust v Mistrust and Autonomy v Shame is a way to describe two important aspects of development, the development of trust on a basic and non-verbal level and the important developmental distinction between shame and guilt. You can read more about this in the book I co-edited, Creating Capacity for Attachment, edited by Arthur Becker-Weidman & Deborah Shell. You can order it from Amazon.com or on my website.

I'm not sure what you mean by "attachment parenting"..it is a loose term that can mean many things...Again, my book has a chapter about parenting in it that you may find helpful. I like the book, The Science of Parenting, so you might look at that. If you are looking for someone to consult with, take a look at the list of registered clinicians at www.attach.org and you will find someone in NC near you. There are several listed. With infants/toddlers, the best general suggestion I can make is that the more time you spend interacting with the child (intersubjectivity) and developing shared, attuned, sensitive responsiveness, the better and this may help with some of the difficulties you may be experiencing. I hope this was helpful for you...of course you can always call me if you'd like to chat or if you'd like a more in depth consultation.
regards,
Art

Arthur Becker-Weidman, PhD said...

Dear LAFernandez,

One other good reference that I often recommend for parents, is Time In Parenting Strategies. When a child becomes dysregulated, the young child needs the parent to regulate the child through the relationship...that may mean being near the child and gradually moving closer to help. The point being that when a child is dysregulated, they are not able to self-regulate and need a parent to help (we see this very clearly in our care of an infant, it is less obvious with a toddler or older child, but still true.

LAFernandez said...

Hi Dr. Becker-Weidman- Thanks for getting back to me so quickly. I will certainly get the books that you suggested. I am using attachment parenting as Dr. Sears defines it, and also, the attachment parenting international ladies have influenced my thinking as well. I ordered tapes from an ATTACh conference in 2005 with a presentation their representatives did. Timely responses to cries, co-sleeping, breastfeeding, baby wearing, and the overall attitude of meeting the need promptly and attuned behaviors have been our philosophy of intentional parenting. I was probably not as guided and intentional about this until he was around 4 months old. I was overwhelmed by his high need temperament and the medical issues he had and took some time to find the resources I needed during that time while trying to survive parenting him! Dr. Sears book, The Fussy Baby likely saved our relationship with him. It really helped me understand the purpose of his behavior and how my responses could improve the chances that he would adjust. He seemed well adjusted until the last few months. We have a 9 month old as well, and it seems that the switch occurred when she became mobile. That's my best guess.

The Love and Logic works to an extent, but when he gets dysregulated, time outs done as the Love and Logic for Early Childhood describes seem to make the dysregulation worse, longer in duration, and more difficult to return to baseline.

The struggle I have is heaping on attention when he becomes dysregulated. I know he still needs help regulating himself, but at the same time, I don't know where the line is for reinforcing tantrums. I can usually tell the difference btw an intentional tantrum and out of control emotional firing. The out of control emotional firing is the incidents in which he will not accept comfort from either of us.

I'd love to chat with you more about this to make sure I'm headed in the right direction! Thanks for offering that to me.

Just to give some of his history. Born prematurely at 36 weeks. Spent 5 days in NICU. Was intubated and hooked up to several things to retrieve blood. Foot was pricked often while he was in there. No physical contact with me until later the next day. Developed colic and reflux. Had strider which we were advised to scope to determine that there was no blockage (around 6 mos.). And the worst one was probably contracting Kawasaki's disease at 3 mos and hospitalized for 5 more days after having the spinal tap, the chest xray, the catherizing, and the many sticks trying to find a vein before being hospitalized that 5 days.

I had been treating adopted and foster children for a couple of years, but I was not aware that early medical trauma played a role in adding risk for attachment problems until after he was born and I attended a seminar in which that was described as well.

We did what we could to mitigate the damage, but it is very apparent that it still affects him. I wondered if EMDR might help.

Anyway-- when are good times to try to reach you?

Thanks so much for you insight and help.

LAFernandez said...

Hi Dr. Becker-Weidman- Thanks for getting back to me so quickly. I will certainly get the books that you suggested. I am using attachment parenting as Dr. Sears defines it, and also, the attachment parenting international ladies have influenced my thinking as well. I ordered tapes from an ATTACh conference in 2005 with a presentation their representatives did. Timely responses to cries, co-sleeping, breastfeeding, baby wearing, and the overall attitude of meeting the need promptly and attuned behaviors have been our philosophy of intentional parenting. I was probably not as guided and intentional about this until he was around 4 months old. I was overwhelmed by his high need temperament and the medical issues he had and took some time to find the resources I needed during that time while trying to survive parenting him! Dr. Sears book, The Fussy Baby likely saved our relationship with him. It really helped me understand the purpose of his behavior and how my responses could improve the chances that he would adjust. He seemed well adjusted until the last few months. We have a 9 month old as well, and it seems that the switch occurred when she became mobile. That's my best guess.

The Love and Logic works to an extent, but when he gets dysregulated, time outs done as the Love and Logic for Early Childhood describes seem to make the dysregulation worse, longer in duration, and more difficult to return to baseline.

The struggle I have is heaping on attention when he becomes dysregulated. I know he still needs help regulating himself, but at the same time, I don't know where the line is for reinforcing tantrums. I can usually tell the difference btw an intentional tantrum and out of control emotional firing. The out of control emotional firing is the incidents in which he will not accept comfort from either of us.

I'd love to chat with you more about this to make sure I'm headed in the right direction! Thanks for offering that to me.

Just to give some of his history. Born prematurely at 36 weeks. Spent 5 days in NICU. Was intubated and hooked up to several things to retrieve blood. Foot was pricked often while he was in there. No physical contact with me until later the next day. Developed colic and reflux. Had strider which we were advised to scope to determine that there was no blockage (around 6 mos.). And the worst one was probably contracting Kawasaki's disease at 3 mos and hospitalized for 5 more days after having the spinal tap, the chest xray, the catherizing, and the many sticks trying to find a vein before being hospitalized that 5 days.

I had been treating adopted and foster children for a couple of years, but I was not aware that early medical trauma played a role in adding risk for attachment problems until after he was born and I attended a seminar in which that was described as well.

We did what we could to mitigate the damage, but it is very apparent that it still affects him. I wondered if EMDR might help.

Anyway-- when are good times to try to reach you?

Thanks so much for you insight and help.

Arthur Becker-Weidman, PhD said...

Your situation if complex and really does deserve more than a brief written blog response. There may be temperament issues to consider, sensory-integration issues, your own past history could play a role, etc. Without a thorough assessment that looked at all these and other issues, it is difficult to give any more specific advice. I have a DVD that describes what a comprehensive evaluation should entail, and my book also has some material on this.

As I'd mentioned, you can probably find someone in your region on the list of registered clinicians at www.attach.org. If you'd like to consult, just call my office and we can arrange a convenient time to chat. I'd be glad to help you.