Behavior
Change As Reported By Caregivers
Of Children Receiving Holding Therapy
By Virginia S. Lester, M.A., L.S.W.
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From
1995 through 1997, data was collected for a freelance research
project on adopted children and adolescents receiving holding
therapy at the Attachment and Bonding Center of Ohio (ABC). The
twelve participating families were clients who sought treatment
for behavioral problems thought to be related to attachment difficulties.
ABC is an internationally recognized treatment facility specializing
in attachment and bonding therapies including holding, rage reduction,
EMDR, sensory stimulation and integrative techniques, and parent
counseling. Interventions are designed to fit the client's individual
needs. As a result, clients may receive intensive treatment (daily
three-hour therapy for 10 days) or less intensive therapy and
may receive any combination of interventions.
The
objective of this study was to see if there was any change in
the client's behavior over time as reported by the primary caregiver.
To measure change, the Devereux Scale of Mental Disorders (DSMD:
Naglieri, LeBuffe, & Pfeiffer, 1994) and the Beech Brook Attachment
Disorder Checklist were used. These instruments were completed
at four points in time: 1) before initial assessment; 2) at the
time of initial assessment; 3) before therapy commenced; and,
4) at follow-up (at least four weeks following therapy began).
Ten subjects received intensive therapy treatment and all 12 subjects
received holding and parent counseling.
THE
SAMPLE
The
sample consisted of twelve adopted children and adolescents, ages
ranging from 4 to 15 years. The racial and ethnic breakout was:
58.3% Caucasian, 16.7% bi-racial, 8.3% African American, 8.3%
Asian, and 8.3% Hispanic. Of the sample, 66.7% were male, 33.3%
were female; 83.3% had received previous treatment related to
emotional and behavioral disturbance; and 66.7% of the sample
had history of taking some type of prescription medication. Subjects
experienced between 0 and 9 out-of-home placements before the
age of two.
THE
INSTRUMENTS
The
Devereux Scale of Mental Disorders (DSMD) is a 110-item (or 111-item
for the adolescent version) behavior rating scale designed to
evaluate behaviors related to psychopathology. There are two separate
instruments, with comparable items and subscales. The instrument
has three composite scores (externalizing, internalizing, and
critical pathology) and each is made up of two subscales (conduct
and attention [or delinquency for adolescents], depression and
anxiety, acute problems and autism). An overall total test T-score
is also included. The DSMD total and composite scales have excellent
internal reliability and test-retest reliability. There is good
interrater reliability with a clinical population. The DSMD is
well suited for use in evaluating mental health treatment outcome
reflecting the full range of psychopathology, including the more
severely disturbed behaviors that are often missing from other
rating scales.
The
Beech Brook Attachment Disorder Checklist is a 75-item checklist
developed by clinicians at Beech Brook to identify negative and
positive attachment behaviors. The instrument is still in the
development stage and was recently piloted on children who are
clients of Beech Brook. Preliminary factor analysis on 101 subjects
yielded two groupings of items — one labeled "positive
attachment" with 17 items, and one labeled "negative
attachment" with 16 items. The two subscales are correlated
with a negative direction and have reliability of .87 and .85.
Mean scores are 1.44 for negative attachment and 2.03 for positive
attachment.
RESULTS
The
mean DSMD total scores decreased across time and between all trials
(79.8 to 68.9) from very elevated to elevated levels. The largest
decrease is between the assessment and the time that therapy commenced.
This change in mean total scores before therapy commenced may
reflect the stress relief of connecting with an empathetic support
person.
The
mean negative Attachment scores also decreased across time and
between all trials (1.7 to 1.4) reaching the 1.44 mean established
by a previous clinical sample. However, the largest decrease in
negative attachment scores occurred after therapy began through
follow-up. Since attachment therapy usually focuses on reducing
the negative attachment behaviors, this decrease may be attributed
to the intense focus of therapy.
The
mean positive Attachment scores increased across time and between
all trials (1.4 to 1.9) and did not reach the 2.03 mean score
established by the previous clinical sample. The largest increase
occurs before the initial assessment indicating, again, that perhaps
parents of attachment disturbed children attain a more positive
perspective after having contacted a supportive person.
In
conclusion, the reported Attachment scores changed with the DSMD
in the expected direction. Specifically, negative attachment scores
and DSMD scores were highest before intervention and decreased
throughout study and positive scores were lowest before intervention
and increased throughout the study. Telephone interviews with
subjects revealed that all participants were extremely satisfied
with the therapy and reported feeling that the treatment that
they received from ABC was superior to previously tried remedies.
While the findings present in this study are very general, they
show that families coping with children wth attachment disorders
find improvement in the child's negative and positive behaviors
over time.
REFERENCES
Naglieri,
J., LeBuffe, P., & Pfeiffer, S.I. (1994). Devereux Scale of
Mental Disorders. San Antonio, TX: The Psychological Corporation.
[CITE
FOR THIS INFORMATION]
Lester,
V.S. (1997). [Behavior change as reported by caregivers of children
receiving holding therapy.] Unpublished raw data.
Lester,
V.S. (1997). Behavior change as reported by caregivers of children
receiving holding therapy. Paper accepted for presentation at
the annual meeting of ATTACh, Omaha, NE.
