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Review
. 2022 Dec;25(4):754-773.
doi: 10.1007/s10567-022-00401-8. Epub 2022 Jun 10.

Attachment- and Emotion-Focused Parenting Interventions for Child and Adolescent Externalizing and Internalizing Behaviors: A Meta-Analysis

Samantha Jugovac  1 , Richard O'Kearney  2 , David J Hawes  3 , Dave S Pasalich  2
Affiliations
Review

Attachment- and Emotion-Focused Parenting Interventions for Child and Adolescent Externalizing and Internalizing Behaviors: A Meta-Analysis

Samantha Jugovac et al. Clin Child Fam Psychol Rev. 2022 Dec.

Erratum in

Abstract

Attachment- and emotion-focused parenting interventions (AE) have grown in popularity as an alternative to behavioral parent training (BPT) for children and adolescents. AE go beneath behavior by helping parents understand and respond to their child's underlying attachment and emotional needs. Past reviews have examined their effects on attachment security and caregiver sensitivity, though less is known regarding their effects on child mental health symptoms. Reported here is the first systematic review and meta-analysis of individual and group AE on externalizing behavior (EXT) and internalizing behavior (INT) for children aged 0-18 years. A search of four databases prior to July 2021 elicited 43 studies that met eligibility criteria. Meta-analysis revealed that AE were superior to waitlist controls for EXT (SMD = - 0.17) and INT (SMD = - 0.34). Effects were sustained at follow-up periods of 6 months and greater, and AE considered to target child mental health were significantly more effective than those that did not in reducing EXT and INT. Two studies retrieved directly compared AE to BPT, which showed no evidence of a difference for follow-up measures of EXT. No studies compared AE to BPT on INT. AE demonstrated no evidence of superiority compared to controls for parent mental health. Findings support the potential for AE to reduce EXT and INT in children and adolescents; however, future research should consider the relative effectiveness of AE.

Keywords: Attachment theory; Behavior problems; Emotion socialization; Meta-analysis; Parenting intervention; Parent–child relationship.

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Conflict of interest statement

The authors have no competing interest to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Flowchart of included and excluded studies
Fig. 2
Fig. 2
Risk of bias across studies. Note Other bias refers to the bias within a study that did not appropriately fit in with one of the other categories. Typically, this referred to studies reporting limited information about participants
Fig. 3
Fig. 3
Forest plot of attachment- and emotion-focused parenting interventions versus waitlist controls on externalizing behavior. Note A negative SMD (left of forest plot) refers to favoring the intervention condition, whereas, a positive SMD (right of forest plot) refers to favoring the control condition
Fig. 4
Fig. 4
Forest plot of attachment- and emotion-focused parenting interventions versus waitlist controls on internalizing behavior. Note A negative SMD (left of forest plot) refers to favoring the intervention condition, whereas, a positive SMD (right of forest plot) refers to favoring the control condition
Fig. 5
Fig. 5
Funnel plots for externalizing and internalizing outcomes when attachment- and emotion-focused parenting interventions are compared to waitlist controls. Note Left funnel plot shows studies with externalizing outcomes and the right funnel plot shows studies with internalizing outcomes
Fig. 6
Fig. 6
Forest plot of attachment- and emotion-focused parenting interventions versus active comparators on externalizing behavior. Note A negative SMD (left of forest plot) favors the attachment- and emotion-focused parenting intervention condition, whereas, a positive SMD (right of forest plot) favors the active comparator condition. Two outliers were removed (Becker-Weidman, ; Sprang, 2009). When these outliers were included, SMD = − 0.30, 95% CI [− 0.51, − 0.10], I2 = 80%
Fig. 7
Fig. 7
Forest plot of attachment- and emotion-focused parenting interventions versus active comparator on internalizing behavior. Note A negative SMD (left of forest plot) favors the attachment- and emotion-focused intervention condition, whereas, a positive SMD (right of forest plot) favors the active comparator condition. Sprang (2009) was removed from analyses as an outlier. When included, SMD = − 0.17, 95% CI [− 0.36, 0.02], I2 = 60%
Fig. 8
Fig. 8
Funnel plots for externalizing and internalizing outcomes when attachment- and emotion-focused parenting interventions are compared to active comparator. Note Left funnel plot shows studies with externalizing outcomes and the right funnel plot shows studies with internalizing outcomes
Fig. 9
Fig. 9
Forest plot of attachment- and emotion-focused parenting interventions versus waitlist and active comparators on parent mental health outcomes. Note A negative SMD (left of forest plot) favors the attachment- and emotion-focused intervention condition, whereas, a positive SMD (right of forest plot) favors the comparator condition
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