COS-P for Parents of Children Referred to Child Psychiatric Services (COS-P)

A Randomized and Controlled Trial Using Circle of Security-Parenting for Parents of Children Referred to Child Psychiatric Services.

Background:The quality of attachment is greatly influenced by parental sensitivity. Attachment based interventions are designed to promote parental sensitivity, to change parental mental representations and to improve understanding of the developmental needs of the child. Very few studies have investigated the effect of attachment-based interventions on psychiatric symptoms in children. Targeting parental sensitivity and the parent-child interaction might have an important impact on psychiatric symptoms in a clinical sample of children referred to child psychiatric services. Objectives: The primary objective is to investigate whether Circle of Security-Parenting (COS-P) has an effect on parental sensitivity in parents of children referred to child psychiatric services. The secondary objectives are to investigate the effect on children's behavioral and emotional symptoms and the parental stress and reflective functioning after 10 weeks of intervention and at the 24 week follow-up. The study is also exploring the effect of parental attachment style, parental stress and parental psychopathology on the effect of the intervention. Methods: The trial will include 128 families of children (age 3-8 years) who are referred to child psychiatric services in a randomized and controlled design. Included families will be randomized to COS-P+ Treatment as Usual (TAU) or TAU only. Perspectives: Considering the important impact of the quality of the parent-child relationship on the child's well-being, it is essential to target it in interventions and to investigate the relation with psychiatric symptoms. Generally there is a lack of interventions targeting parental sensitivity in psychiatric child populations. Working with the parents on the child-parent relation, might have an important impact on their children's current psychiatric symptoms and could additionally prevent future psychopathology.

COS-P is a brief, behavioral and insight oriented therapeutic group approach for parents with the aim to promote parental sensitivity and attachment and autonomy in the parent-child relationship. The parents will participate in ten weekly 1,5-hour sessions at the clinic conducted by two COS-certified therapists. Groups will include 4-5 families at a time.

Maternal sensitivity is measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB)

Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB)

Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB)

Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB)

Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB)

Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB)

Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB)

Measured by observing a mother-child interaction and is rated using "Coding Interactive Behavior" (CIB)

Parent questionnaire on their strategies coping with children's negative emotions. Score range 72-504.

Parent questionnaire on their strategies coping with children's negative emotions. Score range 72-504.

Parent questionnaire on their strategies coping with children's negative emotions. Score range 72-504.

Parent self-report measure that assesses parental reflective functioning or mentalizing. Score range 1-126.

Parent self-report measure that assesses parental reflective functioning or mentalizing. Score range 1-126.

Parent self-report measure that assesses parental reflective functioning or mentalizing. Score range 1-126.

Parent questionnaire on their own depressive symptoms. Score range 0-50. Higher scores indicating more severe symptoms.

A short and simple interview-administered screen for personality disorders. Score range 1-8, higher score indicating more problems.

Parent questionnaire on the strength and difficulties of the child. Total difficulties score 0-40. Higher indicating more problems.

Parent questionnaire on the strength and difficulties of the child. Total difficulties score 0-40. Higher indicating more problems.

Parent questionnaire on the strength and difficulties of the child. Total difficulties score 0-40. Higher indicating more problems.

Inclusion Criteria: Children who score equal or above the 93d percentile on CBCL-total score Score above 93d percentile on the CBCL- ODD or aggression scale Informed consent from both custody. Exclusion Criteria: For children: autism spectrum disorders serious psychopathology requiring immediate clinical attention head injury or verified neurological disease intelligence quotient (IQ) <80 medical condition, requiring treatment no informed consent from custody For parents: a diagnosis of schizophrenia bipolar disorder known substance abuse severe intellectual impairment suicide attempt in the past

Bikic A, Smith-Nielsen J, Dalsgaard S, Swain J, Fonagy P, Leckman JF. Protocol for a randomized controlled trial comparing the Circle of Security-parenting (COS-P) with treatment as usual in child mental health services. PLoS One. 2022 Apr 26;17(4):e0265676. doi: 10.1371/journal.pone.0265676. eCollection 2022.