Effectiveness of Mother-Child Interaction Instructional Program Based on Secure Attachment Style on Social Adjustment of Elementary School Students With Anxiety Disorders

Anxiety disorders are a negative factor in mental health and related issues that disrupt a person's normal life. One of the problems of children with anxiety disorders is their difficulties in social adjustment. Because of the high and persistent prevalence of childhood anxiety disorders and their association with social dysfunction, effective prevention and intervention programs are crucial for this particular group of children. Considering that anxiety disorders are among the most common disorders in primary school ages, the group training program, with its time and cost savings, allows access to services for more mothers and children Also, the results of the research have shown a relationship between children's anxiety disorders and social adjustment with the mother–child interaction and the resulting attachment style. This study aimed to evaluate the effectiveness of the mother–child interaction instructional program based on secure attachment style on social adjustment of elementary school students with anxiety disorders.

The research was a quasi–experimental study with a pretest–posttest design with a control group and a 50–day follow–up. The statistical population consisted of all female elementary school students with anxiety disorders studying in District 3 of Tehran City, Iran. The study was conducted from September 2020 to June 2021. The students were studying in the second or third grades of elementary school. The anxiety in the study sample was diagnosed using the Multidimensional Anxiety Scale for Children (MASC) (March et al., 1997) and diagnostic interview with a child psychologist. Using the convenience sampling method, 30 pairs of mother and child were selected as a sample based on the inclusion and exclusion criteria. They were randomly divided into experimental and control groups (each group had 15 pair). The inclusion criteria for children included studying in the second or third grades of elementary school, receiving a diagnosis of anxiety disorders, and no psychiatric or medical illnesses that require medication. The inclusion criteria for mothers included informed consent to participate in research, having at least a diploma, and not participating in a simultaneous educational psychological or therapeutic program. The exclusion criteria included reluctance to continue cooperation, not cooperating in completing the questionnaire at each stage or more than two absences in training sessions. In the pretest, posttest, and follow–up stage, the participants completed the social adjustment subscale of the Adjustment Inventory for School Students (AISS)( Sinha & Singh, 1993). The weekly sessions of the educational program included 12 sessions, including one 60–minute session with mothers and eleven 90–minute sessions with a 15–minute break and two sections without and with children. However, no intervention was provided for the control group. Data analysis was performed using descriptive statistics (mean and standard deviation) and inferential statistics (analysis of variance with repeated measurements and the Bonferroni post hoc test). The obtained data were analyzed in SPSS software version 24, and the significance level of the tests was considered to be 0.05.

The results showed that the effect of the stage (time) (p=0.002), group (p=0.001), and the interaction effect of stage and group (p<0.001) were significant on the variable of social adjustment. Also, in the experimental group, there was a significant difference in the social adjustment variable between the pretest and posttest stages (p<0.001) and the pretest and follow–up stages (p<0.001). However, no significant difference was observed between the posttest and follow–up stages (p=0.812), which showing the sustained effectiveness of the mother–child interaction program over time.

According to the research findings, the mother–child interaction instructional program based on a secure attachment style can increase the social adjustment of elementary school students with anxiety disorders.