Key Publications

• Juffer, F, Bakermans-Kranenburg, M.J. & Van IJzendoorn, M.H. (Eds.) (2007). Promoting positive parenting: An attachment-based intervention. New York/London: Lawrence Erlbaum Associates.
• Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H., & Juffer, F. (2005). Disorganized infant attachment and preventive interventions: A review and meta-analysis. Infant Mental Health Journal, 26, 191-216.  
  Abstract
  Infant disorganized attachment is a major risk factor for problematic stress management and later problem behavior. Can the emergence of attachment disorganization be prevented? The current narrative review and quantitative meta-analysis involves 15 preventive interventions (N=842) that included infant disorganized attachment as an outcome measure. The effectiveness of the interventions ranged from negative to positive, with an overall effect size of d = 0.05 (ns). Effective interventions started after 6 months of the infant's age (d=0.23). Interventions that focused on sensitivity only were significantly more effective in reducing attachment disorganization (d=0.24) than interventions that (also) focused on support and parent's mental representations (d=-.04). Most sample characteristics were not associated with differences in effect sizes, but studies with children at risk were more successful (d=0.29) than studies with at-risk parents (d=-0.10), and studies on samples with higher percentages of disorganized attachment in the control groups were more effective (d=0.31) than studies with lower percentages of disorganized children in the control group (d=-0.18). The meta-analysis shows that disorganized attachments may change as a side effect of sensitivity-focused interventions, but it also illustrates the need for interventions specifically focusing on the prevention of disorganization.
• Juffer, F., Bakermans-Kranenburg, M.J., & Van IJzendoorn, M.H. (2005). The importance of parenting in the development of disorganized attachment: Evidence from a preventive intervention study in adoptive families. Journal of Child Psychology and Psychiatry, 46, 263-274.
  Abstract
  Background: As infant disorganized attachment is a serious risk factor for later child psychopathology, it is important to examine whether attachment disorganization can be prevented or reduced.
  Method: In a randomized intervention study involving 130 families with 6-month-old adopted infants, two attachment-based internention programs were tested. In the first program, mothers were provided a personal book, and in the second program mothers received the same personal book and three home-based sessions of video feedback. The third group did not receive intervention (control group).
  Results: The intervention with video feedback and the personal book resulted in enhanced maternal sensitive responsiveness (d=.65). Children of mothers who received this intervention were less likely to be classified as disorganized attached at the age of 12 months (d=.46), and received lower scores on the rating scale for disorganization than children in the control group (d=.62), In the book-only intervention group children showed lower disorganization ratings compared to the control group, but no effect on the number of infants with disorganized attachment classifications was found.
  Conclusion: Our short-term preventive intervention program with video feedback and book lowered the rate of disorganized attachment. The effectiveness of our intervention documents the importance of parenting in the development of infant attachment disorganization.
• Juffer, F., Bakermans-Kranenburg, M.J., & Van IJzendoorn, M.H. (2005). Enhancing children's socio-emotional development: A review of intervention studies. In D.M. Teti (eds.), Handbook of research methods in developmental psychology (pp. 213-232). Oxford: Blackwell Publishers.
• Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H., & Juffer, F. (2003). Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin, 129, 195-215.
  Abstract
  Is early preventive intervention effective in enhancing parental sensitivity and infant attachment security, and if so, what type of intervention is most successful? Seventy studies were traced, producing 88 intervention effects on sensitivity (n=7,636) and/or attachment (n=1,503). Randomized interventions appeared rather effective in changing insensitive parenting (d=0.33) and infant attachment insecurity (d=0.20). The most effective interventions used a moderate number of sessions and a clear-cut behavioral focus in families with, as well as without, multiple problems. Interventions that were more effective in enhancing parental sensitivity were also more effective in enhancing attachment security, which supports the notion of a causal role of sensitivity in shaping attachment.
• Stams, G.J.J.M., Juffer, F., Van IJzendoorn, M.H., & Hoksbergen, R.A.C. (2001). Attachment-based intervention in adoptive families in infancy and children’s development at age seven: two follow-up studies . British Journal Of Developmental Psychology, 19, 159-180
  Abstract
  In the present study we examined the longitudinal effects of an early attachment-based intervention on children's social development, personality development, and incidence of behaviour problems at age 7. The behaviourally focused intervention was carried out in families with internationally, transracially adopted children placed before 6 months of age. The intervention was implemented during the child's first year of life in mixed families (i.e. adoptive families with biological children) and in all-adoptive families (i.e. adoptive families without biological children). In the small sample of mixed families (N=35), we found delayed positive intervention effects at age 7 on ego-resiliency and optimal ego-control in girls, and on internalizing behaviour problems in both boys and girls. In all-adoptive families (N=112), the intervention had been effective in changing maternal sensitive responsiveness, security of attachment, and infant exploratory competence in early childhood, but enduring intervention effects could not be traced at the child's age of 7.
• Bakermans-Kranenburg, M.J., Juffer, F., & Van IJzendoorn, M.H. (1998). Interventions with video feedback and attachment discussions: Does type of maternal insecurity make a difference? Infant Mental Health Journal, 19, 202-219
  Abstract
  Parent's insecure representations of attachment are associated with lower parental sensitivityy and insecure infant-parent attachment relationships, leading to less optimal conditions for the children's socio-emotional development. Therefore, two types of short-term intervention were implemented in a group of lower middle-class mothers with an insecure representation of attachment as assessed with the Adult Attachment Interview. In one group of mothers, the intervention efforts were directed at promoting maternal sensitivity by means of written information about sensitive parenting and personal video feedback. In the other group, additional discussions about the mothers' early attachment experiences took place, aiming at affecting the mothers' attachment representation. The interventions were implemented during four home visits between the 7th and the 10th month afther the baby's birth. Preliminary results on 30 mothers pointed at an intervention effect: Mothers in both intervention groups were more sensitive at 13 months than mothers in a control group, t(28)=-2.3, effect size d=.87, p=.01. Mothers who were classified as insecure dismissing tended to profit most from video feedback, whereas mothers who were classified as insecure preoccupied tended to profit most from video feedback with additional discussions about their childhood attachment experiences, F(1,16)=1.9, d=.65, p=.19.