Abstract Background Attachment disorders in preschool children are closely related to internalization and externalization behavioral problems, anxiety and social maladjustment. However, existing interventions mostly focus on individual symptoms, and there is a lack of systematic connection among kindergartens, families and community health services. Although previous studies have confirmed that family upbringing styles, family functions and parent–child relationships can influence the emotions and behaviors of preschool children through social emotional mediation mechanisms, the community-based integrated attachment disorder intervention model for preschool children is still relatively lacking at present. To this end, the study embedded attachment-oriented intervention into regular child health care and community parent courses, and systematically evaluated the effectiveness of the intervention program for attachment disorders in preschool children led by community caregivers. Methods A practical cluster randomized controlled trial was conducted in six community health service districts in a certain city. A total of 132 children aged 3 to 6 years with positive screening results for attachment disorders and their primary caregivers were included and randomly assigned to the intervention group and the conventional care group according to the districts. The intervention trial activities are divided into three types: (1) Weekly parent groups, focusing on themes such as sensitivity, authoritative parenting, and emotional coaching. (2) Structured homework in the form of attachment-oriented parent–child games and interactive exercises. (3) Group sandplay activities for children to support emotional regulation and the development of psychological theory. Results The comparison results between the intervention group and the control group after community follow-up are shown in Table 1. Compared with conventional care, the intervention group showed significant improvement in attachment security, with an adjusted difference of 0.56, p.001, and a total behavioral problem score of -4.3, p=.001. The total behavioral problems and anxiety symptoms of the children in the intervention group decreased from 58.4 and 19.8 to 52.00 and 14.9 respectively, indicating that the improvement in their peer interaction ability and parental sensitivity was also more significant. This further demonstrates that the research intervention achieved a moderately large quantitative effect. Discussion The findings suggest that a comprehensive program integrating parent training, attachment-oriented comprehensive play-based intervention and follow-up support into routine community mental health nursing can effectively improve attachment security and socio-emotional functioning in preschool children with attachment difficulties within 12 weeks and represents a feasible, scalable intervention pathway at the primary-care level.
Jing Li (2026) studied this question.