Video feedback for parental sensitivity and attachment security in children under five years

Emily R Smith, Jane Barlow, Nuala Livingstone, Nadeeja INS Herath, Yinghui Wei, Thees Frerich Spreckelsen, Geraldine M Macdonald

Research output: Contribution to journalReview article (Academic Journal)peer-review

21 Citations (Scopus)
117 Downloads (Pure)


Background Children who are securely attached to at least one parent are able to be comforted by that parent when they are distressed and explorethe world confidently by using that parent as a 'secure base'. Research suggests that a secure attachment enables children to functionbetter across all aspects of their development. Promoting secure attachment, therefore, is a goal of many early interventions. Attachmentis mediated through parental sensitivity to signals of distress from the child. One means of improving parental sensitivity is throughvideo feedback, which involves showing a parent brief moments of their interaction with their child, to strengthen their sensitivity andresponsiveness to their child's signals.ObjectivesTo assess the effects of video feedback on parental sensitivity and attachment security in children aged under five years who are at riskfor poor attachment outcomes.Search methodsIn November 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, nine other databases and two trials registers. We alsohandsearched the reference lists of included studies, relevant systematic reviews, and several relevant websitesSelection criteriaRandomised controlled trials (RCTs) and quasi-RCTs that assessed the effects of video feedback versus no treatment, inactive alternativeintervention, or treatment as usual for parental sensitivity, parental reflective functioning, attachment security and adverse effects inchildren aged from birth to four years 11 months.Data collection and analysisWe used standard methodological procedures expected by Cochrane.
Main resultsThis review includes 22 studies from seven countries in Europe and two countries in North America, with a total of 1889 randomised parent-child dyads or family units. Interventions targeted parents of children aged under five years, experiencing a wide range of difficulties (suchas deafness or prematurity), or facing challenges that put them at risk of attachment issues (for example, parental depression). Nearly allstudies reported some form of external funding, from a charitable organisation (n = 7) or public body, or both (n = 18).We considered most studies as being at low or unclear risk of bias across the majority of domains, with the exception of blinding ofparticipants and personnel, where we assessed all studies as being at high risk of performance bias. For outcomes where self-reportmeasures were used, such as parental stress and anxiety, we rated all studies at high risk of bias for blinding of outcome assessors.Parental sensitivity. A meta-analysis of 20 studies (1757 parent-child dyads) reported evidence of that video feedback improved parentalsensitivity compared with a control or no intervention from postintervention to six months' follow-up (standardised mean difference (SMD)0.34, 95% confidence interval (CI) 0.20 to 0.49, moderate-certainty evidence). The size of the observed impact compares favourably toother, similar interventions.Parental reflective functioning. No studies reported this outcome.Attachment security. A meta-analysis of two studies (166 parent-child dyads) indicated that video feedback increased the odds of beingsecurely attached, measured using the Strange Situation Procedure, at postintervention (odds ratio 3.04, 95% CI 1.39 to 6.67, very low-certainty evidence). A second meta-analysis of two studies (131 parent-child dyads) that assessed attachment security using a differentmeasure (Attachment Q-sort) found no effect of video feedback compared with the comparator groups (SMD 0.02, 95% CI −0.33 to 0.38,very low-certainty evidence).Adverse events. Eight studies (537 parent-child dyads) contributed data at postintervention or short-term follow-up to a meta-analysisof parental stress, and two studies (311 parent-child dyads) contributed short-term follow-up data to a meta-analysis of parental anxiety.There was no difference between intervention and comparator groups for either outcome. For parental stress the SMD between videofeedback and control was −0.09 (95% CI −0.26 to 0.09, low-certainty evidence), while for parental anxiety the SMD was −0.28 (95% CI −0.87to 0.31, very low-certainty evidence).Child behaviour. A meta-analysis of two studies (119 parent-child dyads) at long-term follow-up found no evidence of the effectiveness ofvideo feedback on child behaviour (SMD 0.04, 95% CI −0.33 to 0.42, very low-certainty evidence).A moderator analysis found no evidence of an effect for the three prespecified variables (intervention type, number of feedback sessionsand participating carer) when jointly tested. However, parent gender (both parents versus only mothers or only fathers) potentially has astatistically significant negative moderation effect, though only at α (alpha) = 0.1
Original languageEnglish
Article numberCD012348
Number of pages108
JournalCochrane Database of Systematic Reviews
Issue number11
Early online date29 Nov 2019
Publication statusE-pub ahead of print - 29 Nov 2019

Structured keywords

  • SPS Centre for Research in Health and Social Care


  • child
  • child, preschool
  • female
  • humans
  • infant
  • infant, newborn
  • male
  • child development
  • emotions
  • Object Attachment
  • child rearing
  • parents
  • psychology
  • randomized controlled trials


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