Protocol for a randomized controlled trial comparing the Circle of Security-parenting (COS-P) with treatment as usual in child mental health services.
Protocol for a randomized controlled trial comparing the Circle of Security-parenting (COS-P) with treatment as usual in child mental health services.
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DOI：
10.1371/journal.pone.0265676
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Leckman, James F.
中科院分区：
文献类型：
--
作者：
Bikic, Aida;Smith-Nielsen, Johanne;Dalsgaard, Soren;Swain, James;Fonagy, Peter;Leckman, James F.
儿童对其主要照顾者的依恋质量对其长期的社会情感发展起着重要作用。虽然“安全”依恋与更好的结果相关，但“不安全”依恋与外部化和内部化症状的风险较高相关。被转介到精神卫生服务机构的儿童显示出比一般人群更高的不安全依恋率，但父母与子女的关系很少成为治疗的重点。依恋质量与父母的敏感反应密切相关，这是基于依恋的干预措施，如安全圈（COS）的目标。COS已被证明可以提高依恋质量以及孩子和父母的幸福感。没有随机对照试验调查COS对父母敏感性和儿童精神症状的影响。探讨COS-P作为常规治疗（TAU）的补充是否可以增加观察到的母亲敏感性并减少儿童的精神症状。在一项随机对照平行优效性试验中，将COS-P与TAU在转诊至儿童心理健康服务机构的儿童的父母中进行了比较（n = 186）。如果他们的孩子在3 - 8岁之间，并且CBCL总分和对立违抗性障碍或品行障碍子量表的得分≥ 93 d百分位数，则将家庭以2：1随机分配到干预组或对照组。主要结果是母亲的敏感性，次要和探索性结果包括，除其他外，儿童精神症状，父母的压力和应对儿童的负面情绪。在治疗前（T0）、治疗10周后（T1）和6个月后（T2）评估结局和不良事件。将对所有结局进行回归分析和/或ANOVA。针对亲子关系有可能减少儿童的精神症状。这项试验将提供有价值的信息，如果依恋为基础的干预措施，如COS-P可以加强治疗，像往常一样，在儿童心理健康服务。ClinicalTrials.gov标识符：NCT 03578016。
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. 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). 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. 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. ClinicalTrials.gov Identifier: NCT03578016.
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