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Unresolved states of mind regarding experiences of loss/abuse (U/d) are identified through lapses in the monitoring of reasoning, discourse, and behavior surrounding loss/abuse in response to the Adult Attachment Interview. Although the coding system for U/d has been widely used for decades, the individual indicators of unresolved loss/abuse have not been validated independently of the development sample. This study examined the psychometric validity of U/d, using individual participant data from 1,009 parent–child dyads across 13 studies. A latent class analysis showed that subsets of commonly occurring U/d indicators could differentiate interviewees with or without unresolved loss/abuse. Predictive models suggested a psychometric model of U/d consisting of a combination of these common indicators, with disbelief and psychologically confused statements regarding loss being especially important indicators of U/d. This model weakly predicted infant disorganized attachment. Multilevel regression analysis showed no significant association between ratings of unresolved other trauma and infant disorganized attachment, over and above ratings of unresolved loss/abuse. Altogether, these findings suggest that the coding system of U/d may have been overfitted to the initial development sample. Directions for further articulation and optimization of U/d are provided.

Improving parenting, child attachment, and externalizing behaviors: Meta-analysis of the first 25 randomized controlled trials on the effects of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). VIPP-SD combines support of parental sensitive responsiveness with coaching parents in sensitive limit setting. Here, we present meta-analyses of 25 RCTs conducted with more than 2,000 parents and caregivers. Parents or children had various risks. We examined its effectiveness in promoting parental cognitions and behavior regarding sensitive parenting and limit setting, in promoting secure child–parent attachment, and reducing externalizing child behavior. Web of Science, MEDLINE, PubMed, and recent reviews were searched for relevant trials (until May 10, 2021). Multilevel meta-analysis with META, METAFOR, and DMETAR in R took account of the 3-level structure of the datasets (studies, participants, measures). The meta-analyses showed substantial combined effect sizes for parenting behavior (r = .18) and attitudes (r = .16), and for child attachment security (r = .23), but not for child externalizing behavior (r = .07). In the subset of studies examining effects on both parenting and attachment, the association between effect sizes for parenting and for attachment amounted to r = .48. We consider the way in which VIPP-SD uses video-feedback an active intervention component. Whether VIPP-SD indeed stimulates secure attachment through enhanced positive parenting remains an outstanding question for further experimental study and individual participant data meta-analysis.

Displaying selective attachment behaviours is an important developmental milestone for children with severe or profound intellectual disabilities (SPID). In the current study, between-child differences in their selective emotional responses to comfort provided by parents versus strangers were observed. We explored links between these differences and parental sensitivity and motor competence. A home-based experimental observation was conducted in 38 parent-child dyads, exposing children to four naturalistic stressors and to comfort provided by either their parents or a stranger. Emotional behaviour (arousal and valence) was micro-coded and differentiation variables were constructed, reflecting the children’s level of differentiation between the parent and the stranger. Parental sensitivity was coded using the Emotional Availability Scales. Results showed that these children’s differentiated responses to comfort were related to children’s motor competencies (particularly their fine motor skills), but not to parental sensitivity. This study shows the need to go beyond sensitivity to understand individual differences in the most basal aspects of attachment for children with SPID.

Background:The multi-disciplinarity of long-term care for people with intellectual disabilities makes organisations seek stability and predictability, complicating implementing innovations. Interventions to implement a method for reducing restrictive measures were analysed through the lens of Normalisation Process Theory to understand the social mechanisms at play.Methods:Process notes, collected during a trial in which a method to reduce restrictive measures was implemented, were analysed guided by implementation interventions defined by Cochrane Effective Practice and Organisation of Care Review Group. These interventions were mapped to social mechanisms of Normalisation Process Theory.Results:Implementation interventions were widely used in which clients’ perspectives were expressed (client-related-interventions), and consensus processes were held with care professionals. These interventions initiated NPT’s social mechanisms’ Coherence, Cognitive Participation and Collective Action.Conclusions:The emphasis on consensus and clients’ perspectives when methodically reducing restrictive measures reflects some unique implementation challenges in long-term intellectual disability care.

Background: The fulfilment of basic psychological needs (BPNs) is seen as an integral part of human self-determination, subjective wellbeing, and overall quality of life. However, the meaning of these psychological constructs for individuals with the most extensive support needs remains elusive.Methods: Primary relatives of nine people diagnosed with severe or profound intellectual and multiple disabilities were interviewed about their perceptions of autonomy, competence, and relatedness regarding their family member with complex care needs, and about the ways in which they tried to support their family member in fulfilling specific BPNs. The interview analysis followed a grounded theory with the sensitizing concepts approach.Results: The relatives assigned important meaning to the BPNs, providing insights into their subtle nature, their implicit drivers, and how they were experienced. The relatives also identified serious challenges in detecting, clarifying, and creating opportunities for BPNs. Conclusions: The themes in the relatives’ perspectives can be summarized into a conceptual framework that may contribute to better mutual understanding between people with complex care needs, their relatives, and healthcare providers.

Funder: Project Digitaal op bezoek bij mensen met beperkingen, Funder: Academische Werkplaats Leven met een verstandelijke beperking, Tranzo, Tilburg University, Funder: Academische Werkplaats EMB, Rijksuniversiteit Groningen, Funder: Academische Werkplaats's Heeren Loo ‐ VU, Funder: Academische Werkplaats Sociale relaties en gehechtheid, Bartiméus ‐ VU, BACKGROUND: During the initial phase of the COVID-19 pandemic, many people with disabilities living in home care facilities could not receive visitors. The use of virtual social contact has been recommended by health authorities. This systematic review examined the scientific evidence of the use and feasibility of information and communication technology (ICT) for social contact by people with intellectual disabilities living in care facilities, and potential effects on well-being. METHODS: Five databases were searched using traditional systematic screening and machine-learning supported screening. Findings are presented in a narrative synthesis using thematic analysis. RESULTS: Nine studies were included. We described three themes: means of ICT used for social contact; effects on well-being; and benefits, barriers, and preconditions. CONCLUSIONS: Engaging in virtual social contact may be feasible for people with severe to mild intellectual disabilities, but there is little concrete evidence that this can be used as an alternative for in-person contact.

Home-based parental involvement in early education is linked to beneficial outcomes in children’s development and may redress unequal educational outcomes associated with family background. The type of educational activities at home and the way parents provide their support may differ across parents with and without a migration background. It is unclear whether home-based parental involvement is measured as the same construct across different origin groups. In this study, the psychometric properties of two parent-report questionnaires on home-based parental involvement were evaluated in 131 Dutch mothers of kindergarten-aged children, of whom 47% had a migration background. The dimensional structure of both questionnaires was tested with Principal Component Analysis. Multi-group confirmatory factor analyses were conducted to test for measurement invariance of the ‘Parenting Questionnaire’ across migration background. Results supported the multidimensional nature of home-based parental involvement, as formal and informal activities formed distinct components in the involvement of this diverse parent sample. In addition, measurement invariance was largely confirmed, indicating that parent’s involvement style can be validly measured across parents with and without a migration background in the Dutch context. Incorporating both formal and informal activities with involvement styles is recommended when measuring home-based parental involvement in different origin groups.

Children with chronic illness (CI) are at risk for internalizing problems, which reduce their quality of life, hamper treatment, and increase family stress. Accordingly, behavioral interventions are provided at the family level. However, the effects of parental involvement on child outcomes are not consistently beneficial. Therefore, it is relevant to study the working mechanisms. In the present study, we tested child coping and parenting stress as underlying mechanisms of the effect of an intervention for children and an additional group intervention for parents. Data were analyzed from a randomized controlled trial. Families of children with chronic illness (N = 120, child M age = 12.11 years, range 7.98–18.07) participated in a cognitive-behavioral-based group intervention and were randomized in the child-only intervention or parent–child intervention. Primary outcomes were parent- and child-reported internalizing problems, whereas the mediators were the use of child active coping skills and parenting stress. The causal model was tested with multilevel mediation analysis. Active coping skills and parenting stress stood out as significant mediators of the effect of the intervention on parent- and child-reported internalizing behavior (Cohen’s d effect size range 0.29–1.57). When parents were involved in the intervention, children increased their use of active coping skills and parents decreased in parenting stress, which in turn improved child internalizing problems. Knowing that coping skills and parenting stress underlie the benefit of involving parents can be used for optimizing interventions for children with CI and addressing the risk of internalizing problems.

Unresolved loss/trauma in the context of the Adult Attachment Interview (AAI) has been theorised to result from dissociative processing of fear-related memories and ideas. To examine the plausibility of this model, this study tested hypothesised associations between unresolved loss/trauma and indicators of autonomic nervous system (ANS) reactivity. First-time pregnant women (N = 235) participated in the AAI while heart rate (interbeat interval; IBI) and indicators of parasympathetic reactivity (respiratory sinus arrhythmia; RSA) and sympathetic reactivity (pre-ejection period; PEP, skin conductance level; SCL) were recorded. Using multilevel modelling, ANS reactivity was examined in relation to topic (loss/trauma versus other questions); discussion of actual loss/trauma; classification of unresolved/disorganised; and unresolved responses during the interview. Responses to loss/trauma questions and discussion of loss were associated with respectively larger and smaller IBIs. There was no moderation by unresolved/disorganised status. Unresolved responses about loss were associated with smaller IBIs. Participants classified as unresolved/disorganised showed decreasing PEP and blunted SCL throughout the whole interview. The findings suggest that unresolved speech about loss co-occurs with physiological arousal, although the inconclusive findings regarding parasympathetic and sympathetic nervous system responses fail to clearly support the role of fear.

An individual participant data meta-analysis was used to test pre-registered hypotheses about how the configuration of attachment relationships to mothers and fathers predicts children’s language competence. Data collected from seven studies (published between 1985 and 2014) and 719 children (mean age: 19.84 months; 51.2% female; 86.9% White) were included in the linear mixed effects analyses. Results indicated that children with two secure or organized attachment relationships had higher language competence scores compared to children with one or no secure or organized attachment relationships with their parents (d = 0.26 and d = 0.23, respectively). Furthermore, mother-child and father-child attachment quality did not differentially predict language competence, supporting the equal significance of attachment to both parents in predicting developmental outcomes.

Children's behaviour and mental health has the power to surprise us, readers and authors of the Journal of Child Psychology and Psychiatry and laymen alike, if not for the endless variation among people, then for the ever-changing context in which they develop. The hypothetico-deductive method in combination with null-hypothesis significance testing has turned surprise into scientific knowledge. Null effects may in themselves also be surprising and informative, but appear less well represented in the literature. This editorial highlights emerging methodological practices for studying null effects in the most informative way.

BackgroundThe feasibility and acceptability was explored of the newly-constructed Attachment Strengths and Needs Interview for parents of children with severe or profound intellectual disabilities.MethodA partially mixed methods approach (with focus on the quantitative data) was used to clarify parents’ and professionals’ viewpoints regarding the acceptability of the interview through websurvey-ratings.ResultsParents generally felt appreciated during or after the interview, were motivated to work on the proposed goals and felt the interview covered their actual needs, but were, however, more neutral on the aspects of reflection and learning. Professionals indicated that the interview gathered sufficient information on most elements of interest at the start of an intervention trajectory, but generally missed information on the origins of parents’ questions and the families’ expectations towards taking part in an intervention.ConclusionsThe current study showed preliminary support for the feasibility and acceptability of the Attachment Strengths and Needs Interview, as part of a broader intake procedure, to inform attachment-focused interventions for parents of children with disabilities by identifying their strengths and needs.

BACKGROUND: Professionals in child healthcare increasingly endorse the support of self-management in paediatric rehabilitation services for children with physical disability. Less understood though are their views regarding the role of the children's parents, as well as their own role in supporting parents. This study aimed to investigate the motivation of rehabilitation professionals to support self-management of parents regarding their child with physical disability, professionals' beliefs about parental self-management, and the perceptions underlying their motivation.METHODS: A mixed-methods strategy was followed using a survey among rehabilitation professionals (n = 175) and consecutive semi-structured interviews (n = 16). Associations between autonomous (intrinsic) versus controlled (extrinsic) motivation and beliefs on parental self-management were tested. For deeper understanding of their motivation, directed content analysis was used to address key themes in the qualitative data extracts.RESULTS: Professionals reported autonomous motivation for parental self-management support more often than controlled motivation (t(174) = 29.95, p < .001). Autonomous motivation was associated with the beliefs about the importance of parental self-management (r = .29, p < .001). Approximately 90% of the professionals believed that parents should have an active role, though less than ten percent considered it important that parents also are independent actors and initiative takers in the rehabilitation process. Interviews revealed that individual professionals struggled with striking a balance between keeping control and "giving away responsibility" to parents. A "professional-like" attitude was expected of parents with "involvement" and "commitment" as essential preconditions. Furthermore, professionals expressed the need for additional coaching skills to support parental self-management.CONCLUSION: Professionals were predominantly autonomously motivated to support self-management of parents. However, the dilemmas in giving or taking responsibilities within the partnership with parents, may limit their effectiveness in empowering parents. Reflection on the potential gaps between professionals' motivation, beliefs, and actual behaviour might be crucial to support parental self-management.

© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.This paper prospected the evidence synthesized in meta-analyses on child–parent attachment to discuss its implications for the future of attachment research. Based on the 75 identified meta-analyses, effect size benchmarks may need to be adjusted to small (r = .10), medium (r = .20), and large (r = .30). Topics of attachment meta-analyses predominantly (53%) reflected interest in testing theory. Bibliometric analysis of scientific publications (k = 7,595) that cited these meta-analyses reflect waxing uptake in work on interventions, mental health, and attachment anxiety/avoidance and waning uptake in work on attachment relationships and representations, except for the subtopics of sensitivity and fathers. Prospects for scientifically rigorous research are to be found in engagement with stakeholders working to address important societal challenges. Promoting nurturing care and reducing harm in child welfare contain “Goldilocks-problems” that are amenable to incremental progress while simultaneously advancing theory and methods.

The concept of parental burnout has been proposed to be helpful for describing and understanding the impact of parenting children with complex care needs (CCN). The objective of this scoping review was to investigate, among parents of children with CCN (i) how burnout is conceptualized, (ii) differences in burnout scores, (iii) the prevalence of burnout, and (iv) the associated factors related to burnout. A stakeholder consultation including six parents of children with CCN, three healthcare professionals, and three researchers, was conducted to understand their perspectives on important insights and gaps from the literature. A total of 57 articles were eligible for inclusion. Conceptualization of parental burnout varied widely across studies, with few studies investigating the meaning of the concept for parents. Burnout scores were higher among parents of children with CCN and prevalence estimates varied between 20 and 77%, and exceeded burnout among parents of children without CCN. Few studies included associated factors in the context of parenting and caregiving. Stakeholders endorsed the importance of studies into the multifactorial determination of burnout in the context of parenting and caregiving children with CCN. The results highlight the extremes of stress and burden experienced by parents of children with CCN. An important gap regards the complex interplay between personal and contextual factors pertaining to risk and resilience.

Attachment and Biobehavioral Catch-up (ABC) is an intervention targeted at enhancing the socioemotional and regulatory functioning of at-risk infants. However, to use the ABC for infants/toddlers with intellectual disabilities/developmental delays (ID/DD) and in novel cultural contexts, such as South Africa, adaptations may be required. This study aimed, therefore, to explore the opinions of clinical experts and perceptions of caregivers regarding the use of ABC for children with ID/DD in South Africa. It also sought to incorporate the experiences of families of children with ID/DD who received, and intervenors who delivered, ABC in its first implementation in South Africa. Semi-structured interviews were conducted with 18 participants. Thematic analysis explicated 12 main themes: Intervention Strengths, Points of Concern, and Recommendations (Experts); Focus on Caregiver-child Relationship, and Intervention Targets and Duration (Caregivers); Benefits of ABC, and Cultural Considerations (ABC Recipients); Focused and Targeted, Value of Feedback, Supportive Supervision, Working Alliance, and Challenges Experienced (ABC Intervenors). Practice and training recommendations include psychoeducation for parents and training for intervenors that is ID/DD-specific, expanding supervision capacity, building intervenors’ cultural/linguistic sensitivity and competence, accessing referral networks, including local Community Health Workers as intervenors, and greater flexibility in how the sessions are organized.

Parents of children with severe disabilities have differing attachment-related support needs. An online vignette study with 25 experts, working in academia and/or clinical practice, was conducted to reflect upon the task of matching intervention components to families, based on their attachment strengths and needs. In two online rounds, the experts first completed an inventory of intervention (n = 25) components and second, they prioritised three components for particular families (n = 22). In addition, they reflected upon their argumentations for selecting these intervention components on different levels, either closely or more remotely connected to the children with disabilities themselves. The most common intervention choice across experts was to converse with parents to increase their understanding in the child’s behaviours and communication. Experts justified their choices at various levels (child, parent, family unit, broader environment and professional). In that way, the current study provided an overview of the large number of elements that professionals and policy need to take into account when providing tailored intervention trajectories to these families. Systematically reflecting upon parents’ attachment-related perceptions, strengths and (support) needs can furthermore stimulate professionals to prioritise their actions. It should, however, be embedded in a broader (diagnostic and contextual) intake procedure.

For families who live in women’s shelters, provision of salubrious activities supports their recovery and resilience. In many fields, natural environments are known to provide such benefits. Using an action research design, this study explored professionals’ perspective on the benefits of nature for family life in women’s shelters. Four researchers and 46 care professionals collaborated for six months on this exploration by forming a Community of Practice (CoP). Thematic analysis of transcripts of CoP meetings and case descriptions showed five themes: nature (1) offers a place for family leisure time, (2) supports social connectedness, (3) supports psychological well-being, (4) offers metaphoric experiences, and (5) supports parenting. The first four themes are in line with insights on the benefits of nature for people in general. Professionals’ explanations of the fifth theme suggest that nature supports parenting by providing relatedness between parent and child, parental feelings of competence, and autonomy in parenting.

This article examines how ‘trauma’ has been conceptualised in the unresolved state of mind classification in the Adult Attachment Interview, introduced by Main and Hesse in 1990. The unresolved state of mind construct has been influential for three decades of research in developmental psychology. However, not much is known about how this measure of unresolved trauma was developed, and how it relates to other conceptualisations of trauma. We draw on previously unavailable manuscripts from Main and Hesse's personal archive, including various editions of unpublished coding manuals, and on Main–Bowlby correspondence from the John Bowlby Archive at the Wellcome Trust in London. This article traces the emergence of the unresolved state of mind classification, and examines the assumptions about trauma embedded in the construct. These assumptions are situated both in the immediate context of the work of Main and Hesse and in terms of wider discourses about trauma in the period. Our analysis considers how a particular form of trauma discourse entered into attachment research, and in doing so partly lost contact with wider disciplinary study of trauma.

Young people may adapt to vision impairment (VI) in a variety of ways. To explore heterogeneity in social participation, data were mined for distinct patterns. Existing data from 258 young people with VI, aged between 26 and 44 years ( M = 35.3 years; SD = 5.07), were clustered. Social participation was measured by four closed-ended questions and the Social Network Map. Loneliness was measured by the De Jong Gierveld Loneliness scale. K-medoids clustering with the Partitioning Around Medoids (PAM) algorithm was used to cluster social participation variables and age.Eight clusters were identified, with participants in the two largest clusters, clusters 1 ( n = 84) and 2 ( n = 50), scoring high on almost all social participation outcomes. Participants in cluster 8 ( n = 14) had the lowest social participation scores. However, also over half of the participants in clusters 4, 5, 6, and 7 experienced feelings of loneliness. Findings demonstrate considerable heterogeneity in social participation among young people with VI, which however does not link to loneliness. These variations in social participation underline the need for a differentiated approach to address needs of young people with VI.

Finding fulfillment of basic psychological needs may be difficult for parents living in shelters after becoming homeless or after escaping violence. This study tested if experiencing nature was associated with the basic psychological needs of parents in shelters. Need satisfaction and need frustration were measured among parents in shelters (N = 160), with one measurement in the standard indoor context of the shelter and one measurement while experiencing nature. Experiencing nature was associated with enhanced need satisfaction (d = 0.28) and reduced need frustration (d = &minus, 0.24). The effect was especially pronounced for parents with young children. Our findings suggest that the physical environment matters for parents&rsquo, basic psychological need fulfillment as they interact with their children in the context of sheltering. This finding opens a potential avenue for supporting parental functioning and resilience in the face of risk if these effects were to be replicated across settings using controlled experimental designs. At the very least, the findings may be discussed with practitioners and parents in the context of making shelter life and work more conducive to mental health and family functioning.

Inleiding: De Wet zorg en dwang geeft met ingang van 2020 zorgorganisaties voor mensen met een verstandelijke beperking een impuls om methodische innovaties te implementeren die afbouw van onvrijwillige zorg stimuleren. Het Multi-Disciplinair Expertise Team (MDET) is een methode om onvrijwillige zorg versneld af te bouwen. De vraag voor dit onderzoek was welke belemmerende en bevorderende factoren voor implementatie naar voren kwamen bij de implementatie van MDET bij ’s Heeren Loo, zodat hiervan kan worden geleerd voor op- en uitschalen van deze methode. Methode: Deductieve kwalitatieve inhoudsanalyse van geschreven materiaal van MDET consultatietrajecten bij 19 woningen aan de hand van het determinanten-overzicht voor implementatie van innovaties in de gezondheidszorg van Fleuren et al. (2004).Resultaten: Binnen de context van zorgorganisatie, zorgprofessionals, cliënten, en de methode zelf kwamen 9 bevorderende of belemmerende determinanten naar voren: verwacht (on)gemak cliënt, personeelsverloop, personeelscapaciteit, collegiale ondersteuning, verenigbaarheid doelen, duidelijke richtlijnen/procedures, relatieve voordelen, risico’s cliënt en financiële middelen. Middels inductieve analyse kwamen 5 nieuwe determinanten en randvoorwaarden naar voren ten opzichte van het overzicht van de genoemde determinanten uit Fleuren et al. (2004): organisatie nachtdienst, motivatie/weerstand, risico’s andere cliënten, gebouw, en bereidheid ouders/vertegenwoordigers. Discussie: Hoewel het overzicht van Fleuren et al. (2004) ontwikkeld is voor de reguliere gezondheidszorg bleek deze ook bruikbaar voor het identificeren van determinanten bij implementatieprocessen in de langdurige zorg. Tevens bleken nog een aantal aanvullende belemmerende en bevorderende factoren een rol te spelen. Bekendheid geven aan deze determinanten kan bijdragen aan het succes van implementatie in de langdurige zorg.

Background Family violence is a common problem with direct adverse effects on children as well as indirect effects through disruption of parenting and parent-child relationships. The complex interrelationships between family violence, parenting, and relationships make recovery from psychological responses difficult. In more than half of the families referred to mental health care after family violence, the violence continues. Also, the effect sizes of “golden standard” treatments are generally lower for complex trauma compared to other forms of trauma. In the treatment of complex trauma, trauma-focused therapies including cognitive restructuring and imaginal exposure are most effective, and intensifying therapy results in faster symptom reduction. Furthermore, there is promising evidence that adding a parental component to individual trauma treatment increases treatment success. In family-based intensive trauma treatment (FITT), these factors are addressed on an individual and family level in a short period of time to establish long-term effects on the reduction of trauma symptoms and recovery of security in the family. This randomized controlled multicentre study tests if FITT is an effective treatment for concurrent reduction of trauma symptoms of children, improvement of parenting functioning, and increasing emotional and physical security in children, through the improvement of parent-child relationships. Methods The effectiveness of FITT will be tested by a RCT design. A total of 120 adolescents with a history of family violence and PTS symptoms will be randomized to (a) an intensive trauma treatment with a parent and systemic component (FITT), (b) an intensive trauma treatment without these components (ITT), and (c) treatment as usual (TAU, low-frequency trauma treatment with parent therapy and family sessions). Changes in children’s trauma symptoms, child and parent functioning, and emotional and physical security in the family will be monitored before, during, after, and at 3 months follow-up. Discussion Comparing these interventions with and without a high intensive frequency and parenting and family components can help to understand if and how these interventions work and can contribute to the ambition to recover from the impact of family violence and restore emotional and physical security for children and young people. Trial registration Netherlands Trial Register Trial NL8592. Registered on 4 May 2020

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child’s need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments o attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration. info:eu-repo/semantics/publishedVersion

BackgroundPeople with severe to profound intellectual disabilities have particular needs for others to help them regulate stress. Such support may be hampered by difficulties in detecting and interpreting expressions of stress. This study aimed to describe and identify stress-related behaviours and sensitive, stress-regulating responses to these behaviours.MethodVideo recordings of psychotherapeutic interactions between four clients with severe intellectual disabilities and behavioural problems and two attachment therapists were analysed using a stepwise spiral of analysis approach. Stress-related behaviours were identified with a behaviour rating scale for arousal and valence.ResultsDistinct stress-related behaviours were subdivided into stress-specific, non-stress-specific, and client-specific behaviours. Additionally, examples of responsive behaviours to clients’ expressions of varying arousal and valence were found.ConclusionsA wide variety of expressions indicative of different levels of arousal were found, with few expressions specific for stress. The descriptions of responsive behaviours might support parents and caregivers in external stress regulation.