Table 2.
Main findings regarding attachment, limitations and QA
| Study | Main results | Limitations/possible bias | QA (%) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. Bakermans-Kranenburg et al. (2011) | Institutional sample: 10 (55.5 %) Avoidant 5 (27.7 %) Secure 0 (0 %) Resistant 3 (16.6 %) Insecure other No significant main effect of type of care or genotype in continuous attachment disorganisation Interaction between 5HTTLPR and type of care significantly predicted attachment disorganisation (SS or SL genotype in Institutionalised children |
Small sample size/sub groups Quasi-experimental design Other confounds (conditions previous to institutional care, mothers were substance users) |
62.5 | |||||||||
| 2. a. BEIP (Bucharest Early Intervention Project) Zeanah et al. (2005) |
Institutional sample 18.9 % secure (74 % control), 3.2 % avoidant (4.0 % c), 0 % resistant (0 %), 65.3 % disorganized (22 %) 12.6 % unclassifiable 22 % of children in institutions had organized attachments strategies with their favourite caregiver (78 % of community children had) 12.6 % of institutionalized children showed so little attachment behaviour that were deemed “unclassifiable” No relation between length of institutionalization and signs of RAD No differences between the organized and disorganized children in relation to the quality of Caregiving but significant differences with the “unclassified” group who received poorer quality of care The only measure that significantly predicted attachment rating (0–5) in institutionalized sample was quality of Caregiving. Also associated with the organization of attachment In the institutionalized group only, quality of Caregiving was associated to RAD inhibited scores but unrelated to RAD disinhibited scores |
In Scale for attachment formation, they propose a “tentative” cut off point Institutions with poor child caregiver ratios may be not representative of institutions in another countries Cross sectional design Coders not completely blind |
70 | |||||||||
| b. BEIP Smyke et al. (2010) |
CAU (I) | FC | Community | Foster Care program especially designed. May be not representative of other foster care Institutional characteristics (same as a) Assessment at 42 used a different coding system than at baseline (and variations were seen in all groups not only in FC) |
75 | |||||||
| Secure | 17.5 | 49.2 | 64.7 | |||||||||
| Avoidant | 24.6 | 19.7 | 11.8 | |||||||||
| Ambivalent | 12.3 | 8.2 | 13.7 | |||||||||
| Disorg. | 5.3 | 13.1 | 9.8 | |||||||||
| Insec. other | 40.4 | 9.8 | 0 | |||||||||
| No gender differences in classification but in FC sample more girls were organised at 42 months Main effect of group for security ratting (first community, then Foster Care and finally CAU/Institutional sample) No associations to Quality of Caregiving Foster Family placement causally related to improvement in children’s attachment status |
||||||||||||
| c. BEIP McLaughlin et al. (2012) |
Same as BEIP b. but presents gender differences at 42 months: Females FC 63.3 % and IN 12.1 % secure (p < .001*) Males FC 35.3 % and IN 20.7 % secure (p = .205) Boys and girls with secure attachment had lower levels of internalising symptoms. |
Characteristic of institutions (as previous) and Foster Care program limits generalisation of results | 75 | |||||||||
| d. BEIP Bos et al. (2011) |
Secure attachment: 65 % Never Institutionalised, 49 % Foster Care 18 % in Care as Usual Institutional Fewer signs of inhibited RAD in FC and NI Significant differences between groups in disinhibited RAD only at 42 months Indiscriminate Behaviour more common in Institutionalised, followed by FC and lastly NI Placement in FC before 24 months increased security in attachment and the earlier children were placed, the more organised their attachment was |
Characteristic of institutions (as previous) and Foster Care program limits generalisation of results | 75 | |||||||||
| 3. Bernier et al. (2004) | Attachment in Foster Care: 45.8 % Secure 4.2 % Avoidant 8.3 % Resistant 41.7 % Disorganised Age at placement: Less security when placed older Older children displayed less proximity and less contact maintenance Inconsistency in child’s initial attachment behaviours immediately after placement predicted the development of a disorganised attachment Secure attachment behaviours at placement positively related to proximity seeking in SSP Avoidant behaviours in first days negatively related with contact maintenance in SSP |
Small sample size Mother reported child initial behaviours (not direct observation) |
73 | |||||||||
| 4. a. Cole, S. 2005 (Feb.) |
Attachment in Foster Care: 67 % Secure 4.3 % Insecure Avoidant 0 % Ambivalent 28 % Disorganised/Disoriented/Cannot classify Caregiver’s Trauma as negative predictor for security of attachment. Learning materials as positive predictor for security of attachment Caregiver’s sensitivity as negative predictor (over-involvement) |
Self-selected sample. No information about those that refused to participate (only 69 of 172 agreed, 48 completed) Relatively small sample size Caregiver’s Sensitivity was measured using a sub scale of HOME inventory and not a specific instrument |
77.2 | |||||||||
| b. Cole, S. 2005 (Dec.) |
Attachment in Foster Care (same as reported in previous article a), same sample). Foster Caregiver’s Motivations are related to Infant’s Attachment: Positive predictors for secure attachment were: Desire to increase family size (significant p = .031) and social concern for caregiver’s specific community Predictors for Insecure attachment were: spiritual expression, desire of adoption and replacement of a grown child |
Self-selected sample (as previous) Retrospective design (memory about initial motivations can change) |
72.7 | |||||||||
| c. Cole, S. 2006 |
Attachment in Foster Care (same as reported in a) but analysed differences between kin and unrelated FC: | Potential impact of uneven sample size (n = 12, n = 34) Small sub group sample sizes |
70.8 | |||||||||
| Kin (%) | Unrelated (%) | |||||||||||
| Secure | 67 | 68 | ||||||||||
| Insecure | 8 | 3 | ||||||||||
| Disorganised | 25 | 28 | ||||||||||
| 5. Dozier et al. (2001) | Attachment in Foster Care: 52 % Secure 6 % Avoidant 8 % Resistant 34 % Disorganised Significant association between caregiver’s state of mind and infant attachment Non autonomous and dismissing Foster Mothers tended to have children with disorganised attachment Secure/Autonomous Foster Mothers tended to have secure children |
Older children assessed with SSP (but separate analysis were conducted) Relatively small sample size |
72.7 | |||||||||
| 6. Eulliet et al. (2008) | Attachment in Foster Care: 69.4 % Secure 30.6 % Avoidant 0 % Hyper activated 0 % Disorganised No main effect of age at placement |
Small sample size No information about sample method No information about double coding or blindness of coders to child status |
62.5 % | |||||||||
| 7. Howes and Segal (1993) | Attachment in Institutional Care: 47 % Secure 44 % Avoidant 9 % Ambivalent (No measure of disorganised) Security in attachment associated with sensitivity of Caregiver Length of placement positive association with security of attachment (p < .01) (Institution with indicators of good quality of care) |
Small sample size Majority of children in sample had previous placements No double coding for children in the study |
63 % | |||||||||
| 8. Katsurada, E. | Attachment in: | Small sample and sub groups Sample method not clearly stated No double coding, no IIR Information about the measure used is not clear In FR sample the high percentage of disorganised (refused to elaborate a story) could be related to confound factors in assessment |
50 % | |||||||||
| Institutions (%) | Family reared (%) | |||||||||||
| Secure | 0 | 31.3 | ||||||||||
| Avoidant | 25 | 12.5 | ||||||||||
| Ambivalent | 25 | 25.0 | ||||||||||
| Disorganised | 50 | 31.3 | ||||||||||
| 9. Muadi et al. (2012) | Attachment in: | No detailed information about sampling method and drop out No information about institution beyond the fact that there are one of the “best reputed” |
62.5 | |||||||||
| Institution (%) | Control (%) | |||||||||||
| Secure | 33.3 | 66.7 | ||||||||||
| Insecure Avoidant | 4.7 | 4.7 | ||||||||||
| Insecure Ambivalent | 14.3 | 16.6 | ||||||||||
| Disorganised | 47.6 | 11.9 | ||||||||||
| A factor of Resilience that can promote secure attachment is the establishment of a significant relationship | ||||||||||||
| 10. Moore and Palacio-Quintin (2001) | Attachment in Foster Care to multiple figures 55.5 % Secure with Foster Mother (n = 10 out of 18) 45.5 % Insecure with Foster Mother (n = 8 of 18) 63.1 % Secure with Biological Mother (n = 12 of 19) 36.8 % Insecure with Biological Mother (n = 7 of 19) Attachment to fathers was less secure than attachment to mothers with both biological and foster figures Attachment with mothers was more secure with the biological mother and attachment with father was more secure with the foster figure. However other data presents more positive representations of Foster mothers in comparison to biological parents 6 Adolescents had the same patterns with biological and foster figures and 8 changed their patterns (2 of them building more secure ones with Foster Care and 4 of them more insecure ones) Security in attachment correlates with coping capacity |
Small sample size Sample characterised by having regular contact with biological parents, this limits generalisation Evaluation of attachment representations only based in the Adolescent’s report in a Likert scale All information processed by researcher no inter reliability Rates of attachment not clearly presented and contradictory information |
50 % | |||||||||
| 11. Ponciano Leslie (2010) | Attachment in Foster Care: 58 % Secure 11 % Avoidant 9 % Ambivalent/Resistant 22 % Unclassifiable Maternal Sensitivity: More sensitive FC had more securely attached children Less experienced Foster Mothers tended to have more securely attached children Security in attachment was higher in those children whose FC had decided to adopt them Number of children in Care in same house negatively related to attachment security Age was inversely correlated with attachment security Visit from the biological parents were inversely correlated with attachment security |
No information about parents that declined participation (self-selection) All measures coded by researcher Most measures based in Foster carer’s perceptions |
86 | |||||||||
| 12. Shechory and Sommerfeld (2007) | Attachment in Institutional Care: 39.7 % Secure 25.0 % Avoidant 26.5 % Anxious/Ambivalent 9 % Unclassified Main effect of attachment style in Anxiety/Depression scale The aggression levels were higher for children removed before 7 years old with an insecure attachment but lower for children removed at same age but with secure attachment |
Only one institution No information about quality of care provided or characteristics of the institution Sample with majority of children with Attention deficit disorder or learning disabilities |
59 % | |||||||||
| 13. Vorria et al. (2003) | Attachment in: | Potential impact of uneven sample size (N = 86, N = 42) Sample method not clearly stated Control sample not representative of general population. And had low quality day care Moderate inter-ratter reliability for SSP Institution with indicators of low quality of care can affect generalisation of results |
70.8 | |||||||||
| Institution (%) | Community (%) | |||||||||||
| Secure | 24.1 | 40.6 | ||||||||||
| Avoidant | 2.5 | 9.4 | ||||||||||
| Ambivalent | 7.6 | 25.0 | ||||||||||
| Disorganised | 65.8 | 25.0 | ||||||||||
| Sensitivity in Caregiver’s was significantly different between groups in appropriateness and quality No correlation between attachment quality and Caregiver’s sensitivity or length of relationship | ||||||||||||