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Protocol for a randomized controlled trial comparing the Circle of Security-parenting (COS-P) with treatment as usual
Aida Bikic1,2, Johanne Smith-Nielsen3, Søren Dalsgaard4,5,6
1Child and Adolescent Mental Health Services Southern Jutland, Aabenraa, Region of Southern Denmark, Denmark.
Insights
This study evaluated Circle of Security-Parenting (COS-P) as an addition to treatment for children with mental health needs. The intervention aimed to improve maternal sensitivity and reduce child psychiatric symptoms.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychology
- Clinical Psychology
Background:
- Childhood attachment quality significantly impacts socioemotional development, with secure attachment linked to better outcomes and insecure attachment to increased psychiatric symptoms.
- Children in mental health services exhibit higher rates of insecure attachment, yet parent-child relationship interventions are underutilized.
- Attachment-based interventions like Circle of Security (COS) target parental sensitive responsiveness, demonstrating improvements in attachment and well-being.
Purpose of the Study:
- To determine if Circle of Security-Parenting (COS-P) enhances maternal sensitivity and reduces psychiatric symptoms in children receiving treatment as usual (TAU).
- To investigate the efficacy of COS-P as an adjunctive therapy within child mental health services.
Main Methods:
- A randomized controlled parallel superiority trial comparing COS-P with TAU in parents of children aged 3-8 years with high scores on the Child Behavior Checklist (CBCL) and ODD/CD subscales.
- 186 families were randomized 2:1 to COS-P or TAU, with outcomes assessed at baseline, 10 weeks, and 6 months post-treatment.
- Primary outcome was observed maternal sensitivity; secondary outcomes included child psychiatric symptoms and parental stress.
Main Results:
- Maternal sensitivity was the primary outcome measure.
- Child psychiatric symptoms, parental stress, and coping mechanisms were secondary and exploratory outcomes.
- Data analysis involved regression and ANOVA to compare outcomes between groups.
Conclusions:
- Attachment-based interventions like COS-P hold potential for reducing psychiatric symptoms in children by focusing on the parent-child relationship.
- This trial will provide crucial data on the effectiveness of COS-P as an enhancement to standard care in child mental health settings.
Background:
The quality of a child's attachment to its primary caregiver plays an important role for its long-term socioemotional development. While 'secure' attachment is associated with better outcomes, 'insecure' attachment is associated with a higher risk of externalizing and internalizing symptoms. Children referred to mental health services show much higher rates of insecure attachment than the general population, yet the parent-child relationship is rarely in treatment focus. Attachment quality is closely associated with parental sensitive responsiveness that is target of attachment-based interventions like Circle of Security (COS). COS has shown to improve attachment quality and the well-being of both children and parents. No randomized controlled trials have investigated the effect of COS on parental sensitivity and child psychiatric symptoms in child mental health services.
Objectives:
To investigate whether COS-Parenting (COS-P) can increase observed maternal sensitivity and decrease children's psychiatric symptoms as an add on to treatment as usual (TAU).
Methods:
In a randomized controlled parallel superiority trial COS-P is compared with TAU for parents of children referred to child mental health services (n = 186). Families are randomized 2:1 to intervention or control group, if their child is between 3 and 8 years old and scores ≥ 93d percentile on both the CBCL total score and the oppositional defiant disorder or conduct disorder subscale. Primary outcome is maternal sensitivity, secondary and exploratory outcomes include, among others, child psychiatric symptoms, parental stress and coping with children's negative emotions. Outcomes and adverse events are assessed before (T0) and after 10 weeks of treatment (T1) and 6 months later (T2). Regression analysis and /or ANOVA will be used for all outcomes.
Perspectives:
Targeting the parent-child relation has the potential to reduce psychiatric symptoms in children. This trial will provide valuable information if attachment-based interventions like COS-P can enhance treatment as usual in child mental health services.
Trail Registration:
ClinicalTrials.gov Identifier: NCT03578016.
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