Dyadic Developmental Psychotherapy Identified as an Effective Treatment by UK Institute

IN an exciting development, the Institute for Research and Innovation in Social Services, recognizes Dyadic Developmental Psychotherapy as an evidence-based, effective, and empirically validated treatment. The Institute is a large, internationally regarded institute whose function is to promote positive outcomes in the social service field by identifying evidence informed practice and disseminating research, innovations, and improvements in social services policy, practice, and programming.

The Institutes most recent report, "Insights: Attachment-Informed practice with looked after children and young people, had the following key points:

Attachment behaviour ensures the survival of infants and young children by keeping their caregivers close and available to provide protection and comfort. The attachment relationship provides the context for the main developmental tasks of infancy and early childhood, particularly emotional regulation and the development of the capacity to ‘mentalise’.

The characteristics of caregivers affect the organisation and security of children’s attachment relationships with them. Sensitive, responsive parenting and parental ability to reflect on the infant’s own thoughts and feelings are associated with secure attachments in children.

Children who have experienced maltreatment are significantly more likely to develop disorganised
attachments and these can have lifelong physical, emotional and social consequences.

Recent evidence from neuroscience confirms the importance of the early emotional and social experience of
infants for the healthy development of their brains. Maltreatment can disturb the patterns of cortisol
(stress hormone) secretion which can affect immediate and long term mental and physical health.

Looked after children benefit from developing secure attachments with their caregivers and interventions
should support the development of these, whether children remain at home or are cared for outside their family.

Successful placements are more likely when carers are able to respond to children at their emotional age
rather than their chronological one. Interventions with children should aim to address developmental brain
impairment by providing care that can build fundamental brain capacities. For looked after children this will mean less use of verbal techniques and a greater concentration on physical, sensory and emotional ways of working.

Caregivers should be assessed on their capacity to tolerate difficult behaviour and remain sensitive and
responsive to the needs of children.

Support and training should be provided to caregivers on a frequent and regular basis to ensure that they are able to maintain their capacity to be reflective about children rather than reactive to their behaviour.

Attachment-informed practice may require a policy and culture shift to ensure that children’s needs
are appropriately met when they are cared for away from home.

As you can see their key point that carers should respond to children based on their emotional age rather than their chronological age is supported by our study revealing that children with Complex Trauma and disorders of attachment are substantially younger developmentally than their chronological age:
Becker-Weidman, A., (2009) “Effects of Early Maltreatment on Development: A Descriptive study using the Vineland,” Child Welfare, 88 (2)137-161.

The Institue's paper goes on to state it's support for Dyadic Developmental Psychotherapy as an evidence-informed and validated treatment approach:
Dyadic Developmental Psychotherapy is an attachment-focused approach in which a therapist supports the caregiver and child’s relationship and the development of secure attachment by encouraging the reflective function of the caregiver, enabling attunement, regulating emotion and co creating meaning. The therapist
interactions are characterised by PACE (playfulness, acceptance, curiosity and empathy) and similar qualities are supported in the caregiver with the addition of love (PLACE). This approach has been well evaluated with foster carers and adoptive parents and recently elements of this model have been successfully introduced within residential child care (Becker-Weidman and Hughes, 2008).

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

Instutional life has negative effects on Executive Function

Previous research has shown that children who have spent at least some part of their life in an institution tend to have problems with executive functions. Executive functions are higher brain functions such as working memory, the ability to inhibit one's behavior, forward planning, the ability to move from one task to another, impulse control, the ability to start or initiate, and attention. Instruments such a the Behavior Rating Inventory of Executive Function can be used to measure executive functions.

Past research has concentrated on children aged between six and eleven so researchers at the University of Pittsburgh studied 418 children who had been adopted from institutions in Russia where they had been psychologically, but not physically, deprived. 130 of the children were pre-school age while the rest were older. The study found that the older the age the children had been adopted at the worse their executive function was and that those who were adopted after they were 18 months old had worse executive function than those who had been adopted when they were younger. The onset of adolescence was associated with a greater increase in executive function deficits for children adopted after 18 months than for those adopted when they were younger.

Merz, E. C. and McCall, R. B. Parent ratings of executive functioning in children adopted from psychosocially depriving institutions Journal of Child Psychology and Psychiatry doi: 10.1111/j.1469-7610.2010.02335.x

A study using the Vineland Adaptive Behavior Scales found similar delays, lags, and problems among a group of adopted children.
Becker-Weidman, A., (2009) “Effects of Early Maltreatment on Development: A Descriptive study using the Vineland,” Child Welfare, 88 (2)137-161.
Also see The Center For Family Development for very useful information.

Research Cited

My article detailing the developmental lags of children with complex trauma and disorders of attachment was picked up and described on the Evan B. Donaldson Adoption Institute's Research Summary page.



It is a good summary of the article.

Effects of early maltreatment on development

An empirical study completed by me at the Center for Family Development has just been published in Child Welfare, which is the Journal for the Child Welfare League of America. The article is

Becker-Weidman, A., (2009). Effects of Early Maltreatment on Development: A Descriptive Study Using the Vineland Adaptive Behavior Scales-II, 88(2) pp.137-161.

Children with histories of chronic early maltreatment within a care giving relationship may develop complex trauma or developmental trauma disorder and experience a variety of deficits in several domains. This study explored the effects of complex trauma on the development of 57 children, as measured by the Vineland Adaptive Behavior Scales-II. This is the first descriptive study to report on the significant discrepancies between chronological and developmental ages in adopted and foster children. This study found that adopted and foster children with a psychiatric diagnosis of reactive attachment disorder show developmental delays i the domains of communication, daily living skills, and socialization. The average adaptive behavior composite score for the children in this study yielded a developmental age (age equivalency) of 4.4 years, while the average chronological age was 9.9 years. The study describes the various delays in each domain and then discusses the implications for treatment and parenting, schools, child welfare policy, programs, and practices, and for further research.

Study finds Developmental Delays among children with RAD

The Center's study, "Effects of Early Maltreatment on Development: A Descriptive study using the Vineland Adaptive Behavior Scales-II." has been accepted for publication in a prestigious professional journal and will be in print this summer. The study found the following:
Children with histories of chronic early maltreatment within a care-giving relationship, Complex Trauma, or Developmental Trauma, suffer from a variety of deficits in many domains. This study explored the effects of Complex Trauma on development, as measured by the Vineland Adaptive Behavior Scales-II. This is the first descriptive study to report on the large discrepancies between chronological and developmental ages in adopted and foster children. This study found that adopted and foster children with a psychiatric diagnosis of Reactive Attachment Disorder show developmental delays in several areas. Adaptive behavior and developmental age in the Communication, Daily Living Skills, and Socialization domains was, on average, significantly below the average chronological age of the 57 children in this study. Among children in this study, the average Adaptive Behavior Composite score yielded an age equivalency or developmental age of four years four months, while the average chronological age was nine years ten months.

The article describes the implications of these findings for psychotherapy, parenting, child-welfare policy, and educational settings.

As soon as the article is published I will post information on how to get a reprint.

New Research on Developmental Functioning

We have completed a study that is due to be published soon that shows that children with Reactive Attachment Disorder and Complex Trauma function at a much younger age than their chronological age. The study used the Vineland Adaptive Scales -II and found that the children in the study had a developmental age notably lower than their chronological age. In addition, we found that their receptive communication score was significantly lower than their expressive communication score, suggesting that at times the child's not "listening" may be caused by the child not understanding what the child was asked, rather than being non-compliance or defiance. There are a number of other important findings for this study, which is the first of it's kind to explore the developmental functioning of this group of children.

The article describes several important implications for clinical practice, parenting, child welfare practice, education, and further research.

I will post additional information about this study in later posts and as soon as the article is published, I will provide a link to it.