Attachment representations among school-age children with intellectual disability

Protocol for a mixed-methods randomised controlled trial evaluating the effectiveness of a dyadic expressive arts-based intervention in improving the psychosocial well-being of children with intellectual disability in special schools and their mothers

INTRODUCTION

Mothers of children with intellectual disability (ID) are often distressed because of intensive workloads and difficulties in communicating with their children. Given the interdependence between the psychosocial well-being of such dyads, interventions that promote parent-child relationships and mutual communication would be beneficial. Arts provide alternative avenues for expression and offer an imaginative and playful environment for discovering new communication strategies. Given the lack of studies on arts-based dyadic interventions, this study aims to examine the effectiveness of dyadic expressive arts-based intervention (EXAT) in improving the psychosocial outcomes of children with ID and their mothers and the mother-child relationships.

METHODS AND ANALYSIS

This study will adopt a mixed-methods randomised controlled trial design, wherein 154 dyads of children with ID and their mothers will be randomised into either the dyadic EXAT group or the treatment-as-usual waitlist control group. Quantitative data will be collected at four time points: baseline (T0), postintervention (T1), 3-month postintervention (T2) and 6-month postintervention (T3). Qualitative data will be collected from a subset of 30 mothers in the intervention group at T1 and T3 to document their experiences and perceived changes after the intervention. Mixed-effects models and path analysis will be adopted to analyse the quantitative data, whereas thematic analysis will be applied to the qualitative data. Both sets of data will be triangulated for an integrated view of the effectiveness and mechanism of the intervention.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Human Research Ethics Committee of the University of Hong Kong (Ref. no.: EA200329). Written consent forms will be obtained from all recruited participants (mothers, children with ID and teachers/social workers) before data collection. The study findings will be disseminated in international conferences and peer-reviewed academic journals.

TRIAL REGISTRATION NUMBER

NCT05214859.

Effects of intellectual disability and attachment on hostile intent attribution bias

Understanding hostile intent attribution (HIA) seems important for prevention of problems in social adaptation. This study aimed to explore whether HIA in childhood is determined by both a cognitive factor (i.e. intellectual disability) and an affective factor (i.e. attachment representations). One hundred and eight 8- to 12-year-old children (54 with intellectual disability and 54 with typical development) passed the Attachment Story Completion Task and the Intention Attribution Test for Children. Results indicated that in ambiguous situations, attachment disorganization was associated with HIA, whereas intellectual disability was not. In nonintentional situations, both attachment hyperactivation and intellectual disability were linked with HIA. These results highlight the importance of helping children develop organized attachment representations and optimal activation of their attachment system to prevent social maladaptation.