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Child Attachment &
Play Assessment

About the CAPA

The Child Attachment and Play Assessment (CAPA) assesses attachment and complex trauma in children aged 3 – 11 years.

This is a doll-play procedure which is filmed and usually takes about 25 minutes to adminster. It uses the established narrative story stem procedure in which children are given the beginning of a story (the stem) and then asked to ‘show and tell me what happens next?’  All the stories pull for attachment issues, e.g. the child burns his/her hand on the stove, there is a loud noise in the night when everyone is asleep, little piggy goes for a walk and gets lost. There are two sets of stories, one for children aged 3 — 6 years using the established story stem batteries and another for 7 – 12 year olds using stories developed for the CAPA. We are also piloting a procedure for adolescents.

The CAPA is designed for use with clinical and maltreated populations and has proved a reliable and non-intrusive method for examining young children’s mental representations of attachment and relationships. It is a particularly good procedure for assessing the impact of developmental trauma.

The CAPA is used by independent practitioners and several local authority social service departments in the UK to assess children in need, for understanding the perspectives of adopted and fostered chidlren, and also for court reports. Because children’s stories involve fantasy as well as reality the procedure should not be used to determine whether a child has been abused or maltreated.

Our current research is centred on the bio-physiology of trauma and attachment, specificaly heart rate variability and skin conductance. We are also looking at the relationship between sensory integration and attachment with the view to making finer distinctions between what is organic (e.g. global developmental delay, forms of learning disability and autistic spectrum disorders) and what is attachment/environmentally based. Please see the section "Publications and research" below for details.

Coding system

The CAPA analysis combines Crittenden’s Dynamic Maturational Model of attachment and adaptation (DMM) with Winnicott’s ‘playing and reality’ and ‘potential space’ to assess attachment strategy, mentalising, unresolved loss, and trauma together with the DMM modifiers.

The CAPA was devised by Dr Steve Farnfield who founded the MSc Attachment Studies programme at the University of Roehampton U.K., and with Paul Holmes co-edited the 3 volume Routledge Handbooks of Attachment. He is also a licensed trainer for a wide range of DMM assessment procedures.

Publications and research

The CAPA is an on-going project with half a dozen empirical studies awaiting completion and submission, but only one peer-reviewed publication demonstrating convergent validity with other attachment assessments (Farnfield 2015). The CAPA distinguishes between endangered (largely children in foster care) and community children (Farnfield 2015).

Future work is expected to demonstrate:

  • Construct validity regarding attachment security/insecurity and known risks in the environment (Farnfield unpublished, 2020; Onions unpublished, 2020)
  • Stability of attachment using the CAPA over a two-year period with a group of highly traumatised institutional children was 70% which compares favourably with other studies (Farnfield in preparation, 2020)
  • A significant association between attachment strategy and a clinical diagnosis of anxiety disorder and depression on the CAPA correlated with a diagnosis of depression (Farnfield in preparation, 2020)
  • Correspondence between unresolved trauma on the CAPA and validated trauma scales (Zhang & Farnfield, in preparation)
  • Correspondence of CAPA constructions in case studies with (a) predicted biophysical data (heart rate variability, cortisol) (Hadiprodjo, unpublished, 2018; Zhang in preparation) and (b) cortisol & alpha amylase (Zhang in preparation).

Farnfield, S. (2015). The child attachment and play assessment (CAPA): a
new approach to coding narrative stems with children aged 3 to 11 years. International Journal of Play Therapy. 25, 217-229.

Farnfield, S. (unpublished, 2020) Report for the Mulberry Bush School: attachment, trauma and play. University of Roehampton/ Mulberry Bush School.

Hadiprodjo, N. (unpublished, 2018)Heartfelt Play: An exploratory case-based analysis of cardiac activity within play therapy dyads and children’s play narratives. PhD Dissertation, University of Roehampton.

Onions, C. (unpublished, 2020) From research to practice at a residential school: The Mulberry Bush. British Educational Research Association Conference.

Zhang, F. & Farnfield, S.  (in preparation) Comparing diagnoses of child PTSD with the assessment of developmental trauma.

Zhang, F. (in preparation) The bio-physiology of developmental trauma: cortisol and alpha amylase.

Testimonials

"The CAPA is an extraordinarily informative and valuable clinical tool, which we have often found indispensable in our clinical practice when trying to understand and support young children who have had disrupted experiences of care.

The detailed observation and analysis can reveal a highly nuanced insight into the way young children process information about themselves and their relationships and is a pleasure to use.  The trainers are able to explain the complex and fascinating concepts in ways which are highly accessible.  I cannot recommend the CAPA highly enough."

- Dr Emma Hunnisett, Consultant Clinical Psychologist