Prevention of Attachment Insecurity, Physiological Dysregulation, and Child Behavior Problems

Tuesday, December 13, 2022 - 12:45pm

Hands and Hearts Together

Co-PIs: Susan S. Woodhouse (Lehigh University) &

 Jude Cassidy (University of Maryland, College Park)

Brief statement

Dates: 07/01/2022-06/30/2027

Name of Project: Hands and Hearts Together

Official Study Title: Prevention of Attachment Insecurity, Physiological Dysregulation, and Child Behavior Problems


Funding Source: Eunice Kennedy Shriver National Institute of Child Health & Human Development


This study uses a rigorous randomized controlled trial (RCT) design to test the efficacy of a home visiting version of an attachment-based parenting intervention (Circle of Security-Parenting; COS-P) in reducing the risk of infant/toddler insecure attachment, behavior problems, and dysregulated cortisol reactivity, both immediately after intervention and at 6-month follow up. Participants are 249 low-income, racially/ethnically diverse parent-child dyads enrolled in two diverse Early Head Start programs (in the Lehigh Valley and in Harrisburg, PA). In addition to examining intervention efficacy with respect to child outcomes, we also examine COS-P intervention efficacy in promoting more positive parental responses to child distress at the emotional, physiological, and behavioral levels (immediately after intervention at 6-month follow up). Additionally, the question of “what works for whom” will be investigated by examining key moderators (child temperament, parental attachment style, and parental depressive symptoms). Finally, a mediational model in which parental responses to child distress are thought to mediate intervention effects on child outcomes will be tested.

Amount: $2.8 million

Role/Contribution: Co-PI (with Co-PI: Jude Cassidy, University of Maryland, College Park)



  • A growing body of scientific evidence demonstrates that secure attachment and sensitive caregiving are important sources of resilience for children living in stressful environments (e.g., Graham & Easterbrooks, 2000), contributing to children’s mental and physical health (Shonkoff, 2016). Conversely, research indicates that insecure attachment is an important risk factor for the development of both childhood behavior problems and physiological dysregulation (e.g., Luijk et al., 2010; see Fearon et al., 2010, and Groh et al., 2012, for metanalytic findings). Thus, efforts to foster secure attachment are crucial for promoting the healthy development of children and families.
  • Although a few promising approaches to preventing insecure attachment, physiological dysregulation, and childhood behavior problems have emerged (see Berlin et al., 2016), none has achieved widespread implementation. What is urgently needed is evaluation of a comprehensive theory- and research-based intervention protocol that can be widely implemented among families whose children are at elevated risk for developing or maintaining insecure attachments, physiological dysregulation, and behavior problems.  
  • The Hands and Hearts Together study is a randomized controlled trial (RCT) of an innovative intervention program that can be widely implemented designed to foster children’s secure attachment, promote healthy physiological regulation, and reduce the risk for behavior problems. This intervention program is called Circle of Security – Parenting.
  • We will conduct an RCT with 249 parent-child dyads enrolled in two diverse Early Head Start programs in two communities: the Lehigh Valley and Harrisburg and the surrounding areas.
  • Our goal is to provide support to families participating in Early Head Start (EHS) programs, because EHS families face a number of stressors (e.g., low income, parental depression, exposure to violence/trauma; USDHHS, 2006a) that leave them at increased risk for child insecure attachment and behavior problems.
  • We are delighted to be partnering with the Early Head Start programs at Community Services for Children in the Lehigh Valley and Capital Area Head Start in Harrisburg
  • The project addresses the NICHD CDBB priority of promoting psychosocial adjustment for at-risk children and of understanding contributors to positive outcomes that can occur despite high-risk environments.
  • Moreover, the project addresses a critical barrier to progress in the attempt to reduce the risk of negative outcomes among at-risk children by testing the efficacy of an intervention that was designed in collaboration with families and staff from the real-world contexts in which it will be implemented.
  • Principal aims are to examine whether the addition of this brief attachment-based intervention to regular EHS services will (1) reduce child insecure attachment, physiological dysregulation, and behavior problems; and (2) promote sensitive parental responses to child distress. Additional aims are (3) to examine potential moderators of intervention effectiveness and (4) to test whether changes in parental response to child distress act as a mechanism of positive change.
  • We have chosen HS/EHS as a strong service delivery mechanism because it is a widely available resource in many communities, with an infrastructure and a commitment to the mental health of children. The HS/EHS program has shown positive outcomes in some areas, yet evidence of reducing the risk of insecure attachment is lacking (Spieker et al., 2005).
  • The approach we take is noteworthy in that we consider the broader public health context in which our attachment-oriented prevention protocol can be widely implemented.
Research Focus: 
Infant and Early Childhood Mental Health
Field of Expertise: 
Learning and development