Evidence Base for DDP

The evidence base for DDP as a practice, psychotherapy and parenting approach is steadily growing.

Over the last ten to fifteen years several qualitative and quantitative studies have been undertaken which has helped build a foundation for further research. Our primary aim is to subject the practice of DDP to rigorous research so we can learn more about what works to help children, young people and their families.

Book Cover for Healing Relational Trauma with Attachment-Focused Interventions by Daniel A. Hughes, Kim S. Golding, and Julie Hudson

A recent overview of this work can be found in Chapter 11 DDP Research, Evidence Base, and Outcomes in Healing Relational Trauma with Attachment-Focused Interventions, Hughes, Golding & Hudson, 2019.  These have helped to develop the DDP model and clarify research questions to take forward.

Featured Developments and Future areas of research can be found below.

See the Selected Evidence Base page for more examples and the DDP Library for all evidence base focussed published research.

If you would like to contact the Research Committee about your own work or are interested in helping us do more, please see the Contact the Research team page.

Featured developments

The Relationships in Good Hands Trial (RIGHT)

RIGHT Trial logo - two hands supporting a parent and child

Clinical and cost effectiveness of Dyadic Developmental Psychotherapy for abused and neglected young children with maltreatment-associated problems and their parents

After several years of application and ground work, a research grant from the NIHR for a feasibility trial of DDP as a psychotherapy was awarded in 2019. Led by Professor Helen Minnis of the University of Glasgow with contributions from the Research committee, this is a three phase trial.

Despite the effects of social isolation requirements due to COVID-19, the trial has continued with work being completed during Phase One. Phase One spent careful time establishing how to measure the effects of DDP, how it can be delivered, how a comparison intervention can be described and delivered. This phase has also led to some additional research which is underway.

The trial is now in Phase Two. This is when families will begin to receive DDP in the three trial sites. This phase will examine any practical issues around delivering and studying DDP, suggest improvements and then decide if it can proceed with a randomised control trial which would form Phase Three.

More specifically, the RIGHT Trial will look at whether DDP improves the effects of maltreatment on adopted and fostered children and investigate the cost effectiveness of giving DDP.

It is being conducted over a range of sites from the NHS (Lanarkshire), local authority (ATTACH team) and the third Sector (Adoptionplus, Barnardo’s). The University of Glasgow is leading the study and working closely with DDP Connects UK and the DDPI through good, collaborative working relationships with the Research Committee. Dan Hughes has also helped to establish how DDP can be delivered consistent with the founding principles of his model.

All up-to-date information can be found on the trial website, and by emailing Verity to sign-up to the email newsletter.

Funded by NIHR logo

DDPI supported research projects

Alongside the bid for an RCT trial the research committee has continued to offer support to members wanting to develop small scale quantitative and qualitative research and service evaluation projects.

  1. Developing measures in DDP-the new TAYC-R
  2. Understanding how DDPI can meet the present needs of its practitioners in supporting the evidence base for DDP therapy
  3. NICE guidance recommendations on attachment
  4. Measurement in DDP Guidance
  5. Norway seeks to develop and evaluate DDP
  6. DDP in education

Developing measures in DDP – the new TAYC-R (Adoptionplus)

Professor Julie Selwyn from Oxford Rees Centre was recently commissioned by Adoptionplus, UK to complete a psychometric evaluation of the Thinking About Your Child Questionnaire also known as the Carer Questionnaire. This was originally developed by Kim Golding and subsequently developed by Charlotte Granger and Ben Gurney-Smith while at the Attach team, Oxford.

This evaluation is very promising and positive showing an expected correlation with the Strengths and Difficulties questionnaire. This new version has some developments to help improve the measure and in light of these revisions is accordingly called the Thinking About Your Child Questionnaire – Revised.

Plans are underway to psychometrically test this new version. For the first time, using an extensive database, Adoptionplus have also developed a means of interpreting scores. The measure will also be used in the NIHR study and brings some confidence that the relational and parental variables addressed by DDP may be identified by this measure.

The TAYC-R (Adoptionplus) questionnaire and scorer have been added to the DDP Library and kindly made available to download for Personal Use Only (republishing or reproducing is expressly forbidden, TAYC-R © 2021 Adoptionplus with grateful thanks to Dr Kim Golding and associates).

Understanding how DDPI can meet the present needs of its practitioners in supporting the evidence base for DDP therapy

DDP Research Survey Report 2018 cover

In order to inform the research strategy for DDPI, between May and September 2018 the DDP membership were surveyed in order to baseline the present research activity and interest of its practitioners. Thank you for completing this!

This survey concludes that the majority of respondents are interested in helping with DDP research, just under half have already undertaken some research in DDP and many would like assistance to conduct research.

At DDPI we can provide direction and assistance for those interested in research in setting up, understanding and distributing their findings. The results have helped clarify the terms of reference and aims of the DDPI Research Committee.

DDP Research Survey Report 2018

NICE guidance recommendations on attachment

We are pleased to see DDP is named in the UK National Institute for Health and Care Excellence (NICE) guidance recommending that as a widely used intervention it is therefore subject to rigorous evaluation.

In Children’s attachment: attachment in children and young people who are adopted from care, in care or at high risk of going into care – Recommendations for research, DDP is listed under 3 Evaluation of extensively used interventions, see excerpt below;

3 Evaluation of extensively used interventions

Evaluate currently unevaluated but extensively used interventions for attachment difficulties.

Why this is important

Various interventions are currently used to help address attachment difficulties that may be clinically effective, but without good quality evidence they cannot be considered by NICE.

A randomised controlled trial should be carried out that compares currently unevaluated interventions, such as playtherapy, dyadic developmental psychotherapy, and attachment aware schools program with an evidence‑based treatment for attachment difficulties. The interventions should address children in a wide variety of placements and ages.

Primary outcome measures may include:

  • attachment
  • parental sensitivity
  • placement disruption
  • educational performance
  • behavioural problems.

There should be at least a 6‑month to 1‑year follow‑up. Potential harms also need to be captured. Qualitative data may also be collected on the parents’ and child’s experience of the intervention.


Measurement in DDP GuidanceMeasurement in DDP: Guidance for practitioners and services

To further support members interested in contributing to the development of an evidence base through a range of small and larger scale projects, audits, service evaluations and pilot studies measurement in DDP guidance document has been written.

Measurement in DDP: Guidance for practitioners and services

The Little Book of Attachment © W. W. Norton

More information on measurement in child mental health settings has been included in a recent book by Dan Hughes and Ben Gurney-Smith: Chapter Nine Final Remarks see pp. 235-239 In. Hughes, D. A., & Gurney-Smith, B. (2020). The Little Book of Attachment: Theory to Practice in Child Mental Health with Dyadic Developmental Psychotherapy. WW Norton & Company.

Norway seeks to develop and evaluate DDP

We are pleased to hear that a service in Norway has secured funding for the implementation of DDP Level One and Two training and partial funding for the evaluation research.

We helped consult to the researchers and clinicians to inform their application. The project has been awarded from the South-Eastern Norway Regional Health Authority.

DDP in education

Belonging Book Cover - by Sian Phillips, Deni Melim, Dan Hughes

Sian Phillips has supported the development of an educational program, ‘Belong’ for children who have experienced abuse and neglect and are struggling in their schools. There have been some analyses of the impact of taking this approach with some early promising results suggesting that finding ways of measuring change in an educational setting is still needed.

More about the programme can be found in Sian Phillips new book: Phillips, S.; Melim, D. & Hughes, D. (2020) Belonging. A relationship-based approach to trauma-informed education. Rowan & Littlefield.

Future areas of research

The accumulated evidence to date suggests that we are making progress in establishing the evidence base for DDP but there is more to do.

DDP informed parenting groups, Nurturing Attachment Training Resource and Foundations for Attachment have a research and evidence base but to date, have not been subject to a randomised control trial.

DDP psychotherapy is being investigated currently with a plan as part of this research to conduct a randomised control trial.

DDP practice in education or residential settings is an area which requires further research investigation and may benefit from qualitative study initially to determine the areas which may be subject to evaluation for effectiveness.

If you would like to contact the Research Committee about your own work or are interested in helping us do more, please see the Contact the Research Team page.