Attachment And Biobehavioral Catch-up Intervention Research Articles

The unanticipated side effects of an attachment intervention: Parents ask higher quality questions.

Research suggests foster children are at risk for poor language skills. One intervention, attachment and biobehavioral catch-up (ABC), was shown to successfully improve not only young foster children's attachment to their parents, but also their receptive vocabulary skills (Bernard et al., 2017; Raby et al., 2019). Given that language acquisition is intricately linked to parents' sensitive interactions with their children, we ask whether the ABC intervention also improves the quality of parents' talk addressed to children. We test whether the ABC intervention results in more conversational turns between parents and their children. Crucially, we also look within these conversational turns, assessing the number and types of questions that parents ask children. Results suggest that parents who received the ABC intervention do not have more conversational turns or ask higher numbers of questions, compared to parents who received the control intervention. Rather, parents in the ABC group ask a higher proportion of child-led and restatement questions, and a lower proportion of parent-led and pedagogical questions, compared to the control. Additionally, the higher proportion of child-led questions were related to higher parental sensitivity scores. Together, these results suggest that an intervention originally designed to improve children's socioemotional outcomes had positive benefits for the quality of conversations between parents and children. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A qualitative exploration of caregivers’ experiences with the Attachment and Biobehavioral Catch‐up (ABC) parenting program

In the face of childhood adversity, services and interventions can improve a child's life trajectory by promoting healthy development, enhancing protective factors, and building resilience through stable and supportive relationships. One such service, a specific and highly researched home visiting intervention, Attachment and Biobehavioral Catch-up (ABC), is often provided to families through home visiting service programs. This qualitative descriptive study examines the experiences of caregivers (N=18) who received ABC as part of a statewide early childhood initiative in one midwestern state. Participants provided insight into the context of their lives before and during the intervention. They described their perspectives of the utility of the program and its influence on their family's behaviors and interactions. Findings demonstrate that coaching support bolstered caregivers' confidence in effective strategies and guided them through caregiving challenges. Caregivers observed growth in their caregiving practices, their infants' and young children's social and emotional skills, and their dyadic caregiver-child relationships, demonstrating the benefits of participating in and completing the ABC intervention.

Intervening with Opioid-Exposed Newborns:: Modifying an Evidence-Based Parenting Intervention.

BackgroundPrenatal opioid exposure predisposes infants to adverse development of regulatory systems and jeopardizes their long-term health outcomes. While sensitive caregiving promotes healthy development of emotional and physiological regulation and may remediate risks associated with prenatal opioid exposure, mothers with opioid use disorder often experience unique challenges that make providing sensitive care difficult.RationaleEmpirically tested early interventions, such as the Attachment and Biobehavioral Catch-up (ABC) intervention, can positively impact children’s development following adversity through promoting sensitive caregiving. ABC intervention targets correspond to those parenting behaviors that may be challenging for mothers with opioid use disorder (i.e., nurturing infants who may be difficult to soothe, responding sensitively to infants by following the child’s lead with delight, and avoiding intrusive/frightening behavior), and have positive impacts on child development and regulation. However, given the unique challenges for infants and mothers impacted by opioid use, some adaptations may strategically address those vulnerabilities and thereby maximize the potential benefits for this population.MethodsThe present paper describes modifications made to the ABC intervention for use with pregnant mothers in treatment for opioid use disorder. This modified intervention is currently being examined via a large scale randomized clinical trial (RCT) at the University of Delaware, and a case study is presented here to highlight considerations for working with mothers and infants impacted by opioid use and to exemplify ways that modified ABC addresses the needs of this population.

Ecological Predictors of Parental Beliefs about Infant Crying in a Randomized Clinical Trial of ABC

ABSTRACT Objective: Attachment theory suggests that parent responsiveness to infant distress predicts secure parent–child attachment and subsequent healthy child development. While much is known about microsystem factors that interfere with responsive caregiving, there is a paucity of research investigating how exosystem factors, such as neighborhood crime, affect parenting. Method: In a sample of 200 diverse caregivers and their 5- to 21-month-old infants (M = 11.82; 49% male), we leveraged data from a randomized clinical trial of Attachment and Biobehavioral Catch-up (ABC), an attachment-based intervention, to assess whether individual level burden (indicated by single-parent status, low income, residential instability, young parenthood, parental psychopathology, and own history of early adversity) and neighborhood crime density (geocoded within a 500 ft radius of parent’s residence) were associated with their beliefs about infant crying, an indicator of responsive parenting. Results: Consistent with Bronfenbrenner’s ecological systems' theory of development, both greater exposure to individual burden indicators and greater neighborhood crime density predicted greater maladaptive beliefs about infant crying, suggesting that contextual factors outside the household are associated with parenting cognitions. Further, when accounting for the effect of crime and individual burden on parental beliefs about infant crying, participation in the ABC intervention was effective in reducing maladaptive parenting beliefs. Conclusions: We consider implications for multi-level intervention approaches that target family processes, neighborhood-level factors, and policy initiatives to promote community wellbeing and positive child development.

Promoting Secure Attachment Relationships in Foster Families with the Attachment and Biobehavioral Catch-Up (ABC) Intervention

Promoting Secure Attachment Relationships in Foster Families with the Attachment and Biobehavioral Catch-Up (ABC) Intervention Due to a history of early adversity, foster children often show difficulties in the development of new attachment relationships. The Attachment and Biobehavioral Catch-Up Intervention (ABC) aims to promote sensitive caregiving and the development of secure attachment relationships in foster families by addressing the critical needs of foster children. The ABC intervention was implemented in Germany for the first time. The efficacy of the intervention was tested in a sample of N = 34 foster families with foster children between the ages of 6 to 24 months. Foster parents reported on parenting stress and on attachment behaviors of the child in a diary. Parenting quality was assessed in a semi-structured play situation and attachment quality was assessed with the Strange Situation Procedure. Foster parents showed higher levels of sensitivity post training (p < .001), they reported an increase in secure attachment behaviors in their foster children (p < .05), and the distribution of attachment relationships classified as secure (59 %) and disorganized (12 %) was comparable to distributions found in biological, middle class samples. Although these results still need further validation by larger control group studies, they give a first indication that the ABC program might be an effective tool to support the development of secure attachment relationships in foster families in Germany.

Increasing secure base script knowledge among parents with Attachment and Biobehavioral Catch-up.

This study evaluated whether Attachment and Biobehavioral Catch-up (ABC), a parenting intervention, altered the attachment representations of parents (average age of 34.2 years) who had been referred to Child Protective Services (CPS) due to risk for child maltreatment when their children were infants. Approximately 7 years after completing the intervention, parents who had been randomized to receive ABC (n = 43) exhibited greater secure base script knowledge than parents who had been randomized to receive a control intervention (n = 51). Low-risk parents (n = 79) exhibited greater secure base script knowledge than CPS-referred parents who had received a control intervention. However, levels of secure base script knowledge did not differ between low-risk parents and CPS-referred parents who had received the ABC intervention. In addition, secure base script knowledge was positively associated with parental sensitivity during interactions with their 8-year-old children among low-risk and CPS-referred parents. Mediational analyses supported the idea that the ABC intervention enhanced parents' sensitivity 7 years later indirectly via increases in parents' secure base script knowledge.

Enhancing diurnal cortisol regulation among young children adopted internationally: A randomized controlled trial of a parenting-based intervention.

Children who have been adopted internationally commonly experience institutional care and other forms of adversity prior to adoption that can alter the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. In particular, internationally adopted children tend to have blunted diurnal declines compared to children raised in their birth families. The Attachment and Biobehavioral Catch-Up (ABC) intervention was developed to enhance young children's biological and behavioral regulation by promoting sensitive parenting. The current study used a randomized controlled trial to assess whether ABC improved the diurnal functioning of the HPA axis among 85 children who had been adopted internationally when they were between the ages of 4 and 33 months (M = 16.12). Prior to the intervention, there were no significant differences in diurnal cortisol production between children whose parents were randomly assigned to receive ABC and children whose parents were randomly assigned to receive a control intervention. After the intervention, children whose parents had received the ABC intervention exhibited steeper declines in cortisol levels throughout the day than children whose parents had received the control intervention. These results indicate that the ABC intervention is effective in enhancing a healthy pattern of diurnal HPA axis regulation for young children who have been adopted internationally.

Improving social-emotional competence in internationally adopted children with the Attachment and Biobehavioral Catch-up intervention.

Children adopted internationally experience adverse conditions prior to adoption, placing them at risk for problematic social-emotional development. The Attachment and Biobehavioral Catch-up (ABC) intervention was designed to help internationally adoptive parents behave in ways that promote young children's social-emotional competence. Participants included 131 parent-child dyads randomly assigned to receive either ABC (n = 65) or a control intervention (n = 66). In addition, 48 low-risk biologically related parent-child dyads were included as a comparison group. At follow-up assessments conducted when children were 24 to 36 months old, internationally adopted children who received the ABC intervention had higher levels of parent-reported social-emotional competence than children who received a control intervention. In addition, observational assessments conducted when children were 48 and 60 months of age showed that internationally adopted children who received ABC demonstrated higher social-emotional competence than children who received a control intervention. Adopted children who received the control intervention, but not the ABC intervention, displayed more difficulties with social-emotional competence than low-risk children. Finally, postintervention parent sensitivity mediated the effect of ABC on observed child social-emotional competence in parent interactions, controlling for preintervention parent sensitivity. These results demonstrate the efficacy of a parenting-focused intervention in enhancing social-emotional competence among children adopted internationally.

Secure attachment predicts lower body mass index in young children with histories of child protective services involvement.

Children who experience early adversity are at risk for obesity; secure attachment may be a protective factor as it has been linked to reduced obesity risk. To evaluate whether (1) participation in a parenting intervention and (2) secure attachment were associated with body mass index (BMI) among young children with histories of child protective services (CPS) involvement. A total of 105 parent-child dyads referred following CPS involvement were randomly assigned to receive Attachment and Biobehavioral Catch-up (ABC), which was designed to increase parental sensitivity, or a control intervention. Attachment security was assessed during infancy, and BMI was assessed at annual follow-up visits until children were 4years old. Children in the ABC group were more likely to have secure attachments (52%) than children in the control intervention group (32%). Although the ABC intervention did not have a direct effect on children's BMI, secure attachment was associated with a steeper decline in BMI from age 2 to age 4, with secure children showing significantly lower BMI (M=15.4, SD=2.08; 16.6% overweight/obese) than insecure children (M=17.6, SD=3.81; 35.7% overweight/obese) at age 4. Secure attachment was associated with reduced BMI among CPS-referred children; thus, secure attachment may be a novel target of early obesity prevention efforts.

Effects of the ABC Intervention on Foster Children's Receptive Vocabulary: Follow-Up Results From a Randomized Clinical Trial.

Children with histories of maltreatment and disruptions in care are at elevated risk for impairments in early language development, which contribute to difficulties in other developmental domains across childhood. Given research demonstrating associations between parent responsiveness and children's early language development, we examined whether a parenting intervention administered in infancy improved preschool receptive language skills in children involved with the child welfare system. Attachment and Biobehavioral Catch-up (ABC) is a 10-session intervention that aims to enhance parent-child interactions. The follow-up results of this randomized clinical trial demonstrated that infants who received the ABC intervention ( n = 24) scored significantly higher on a test of receptive vocabulary at age 36 months than infants who received a control intervention ( n = 28). These results provide evidence of the critical role of parental responsiveness in supporting optimal language development among young children with histories of child welfare involvement.

Intervention effects on diurnal cortisol rhythms of Child Protective Services-referred infants in early childhood: preschool follow-up results of a randomized clinical trial.

A number of interventions for at-risk children have shown benefits for children's hypothalamic-pituitary-adrenal axis activity immediately after treatment. It is critical to examine whether such changes are maintained over time, given that physiological regulation is implicated in later mental and physical health outcomes. To examine whether differences in diurnal cortisol production between children receiving the active parenting intervention and children in the control group persisted at a preschool follow-up (approximately 3 years following intervention). Between-subject comparison of cortisol patterns among 2 groups of children (experimental and control groups) involved with Child Protective Services following allegations of neglect. The participants included 115 children (43.5% female) between 46.5 and 69.6 months of age (mean [SD], 50.73 [4.98] months) who had been previously randomly assigned to either the Attachment and Biobehavioral Catch-up (ABC) intervention (n = 54) or the control intervention (n = 61). The experimental ABC intervention focused on 3 aims: increasing parental nurturance to child distress, increasing synchronous interactions, and decreasing frightening parental behavior. The control intervention provided educational information about child development to parents. Both interventions were manualized and involved 10 sessions implemented by a trained parent coach in the families' homes or other places of residence. Salivary cortisol samples collected at waking and bedtime for children on 3 separate days. Analyses revealed significant differences in cortisol production at the preschool follow-up, such that children in the ABC intervention group showed more typical patterns of cortisol production than children in the control intervention group. Specifically, children in the ABC group exhibited higher mean (SD) log-transformed morning levels than children in the control group (-0.87 [0.45] vs -1.05 [0.43] μg/dL, respectively [to convert to nanomoles per liter, multiply by 27.588]; β = 0.18; P = .03). Bedtime cortisol levels did not differ significantly between the ABC and DEF groups (mean [SD], -1.19 [0.49] vs -1.17 [0.48] μg/dL, respectively; β01 = -0.01; P = .87). Those in the ABC group showed a steeper decline in cortisol across the day (mean, -0.31 μg/dL) than those in the control group, who showed a blunted cortisol rhythm (mean, -0.12 μg/dL) (β = -0.19; P = .02). Differences in cortisol production between the experimental and control groups persisted at the preschool follow-up and resembled differences initially observed 3 months following intervention. This is encouraging evidence that the ABC intervention for Child Protective Services-referred children may have long-lasting effects on a physiological stress system critical for health and adjustment. clinicaltrials.gov Identifier: NCT02093052.

Intervening to enhance cortisol regulation among children at risk for neglect: Results of a randomized clinical trial.

The hypothalamus-pituitary-adrenal axis is particularly sensitive to conditions of maltreatment. In particular, neglected children have shown a flatter slope with lower wake-up values relative to nonneglected children. An intervention, the Attachment and Biobehavioral Catch-Up (ABC), was developed to enhance biological and behavioral regulation in young children at risk for neglect. The effectiveness of the intervention was assessed in a randomized clinical trial for children with involvement with Child Protective Services. Following the intervention, children receiving the ABC intervention (n = 49) showed more typical cortisol production, with higher wake-up cortisol values and a steeper diurnal slope, than children receiving the control intervention (n = 51). These results suggest that the ABC intervention is effective in enhancing biological regulation.

Intervention effects on negative affect of CPS-referred children: Results of a randomized clinical trial

Exposure to early adversity places young children at risk for behavioral, physiological, and emotional dysregulation, predisposing them to a range of long-term problematic outcomes. Attachment and Biobehavioral Catch-up (ABC) is a 10-session intervention designed to enhance children's self-regulatory capabilities by helping parents to behave in nurturing, synchronous, and non-frightening ways. The effectiveness of the intervention was assessed in a randomized clinical trial, with parents who had been referred to Child Protective Services (CPS) for allegations of maltreatment. Parent–child dyads received either the ABC intervention or a control intervention. Following the intervention, children from the ABC intervention (n=56) expressed lower levels of negative affect during a challenging task compared to children from the control intervention (n=61).

Parental synchrony and nurturance as targets in an attachment based intervention: building upon Mary Ainsworth’s insights about mother–infant interaction

As an astute observer of parent–infant interaction, Mary Ainsworth described and assessed facets of maternal sensitivity, including responsiveness to conditions of infant distress and non-distress. This paper considers the importance of distinguishing between parental sensitivity to children’s distress cues (which we refer to as nurturance) and parental sensitivity to children’s non-distress cues (which we refer to as synchrony). Observations of parents in our intervention, Attachment and Biobehavioral Catch-up (ABC), have led us to believe that distress and non-distress represent distinct contexts in which parents can be differentially sensitive or insensitive in responding. Thus, we have conceptualized nurturance and synchrony as distinct targets of the ABC intervention and, in deciding how to assess parental sensitivity, we have chosen measures that distinguish between nurturance and synchrony. This paper describes the strengths and weaknesses of different approaches we have taken to assess parental sensitivity, including diary methodology that we developed for assessing parental nurturance and global measures that we have used for assessing parental synchrony. Finally, a frequency-based coding system is described that we developed for assessing parental nurturance and synchrony from videotaped intervention sessions.

Cognitive Flexibility and Theory of Mind Outcomes Among Foster Children: Preschool Follow-Up Results of a Randomized Clinical Trial

Young children who experience early adversity are at risk for problems regulating emotions, behavior, and physiology, which in turn place them at risk for later psychopathology, school problems, and peer relation difficulties. Therefore, early parenting interventions are critical in helping this vulnerable population develop adequate self-regulatory capabilities. Attachment and Biobehavioral Catch-up (ABC) is an intervention developed to help parents learn to behave in ways that enhance young children's self-regulatory capabilities. In the present study, we found that preschool-aged foster children who had received the ABC intervention showed stronger cognitive flexibility and theory of mind skills, relative to foster children who had received a control intervention. Foster children who had received the ABC intervention showed capabilities in these areas that were not significantly different from a comparison group of children who were never in foster care. These findings are promising in suggesting that the ABC intervention enhances the development of foster children's self-regulatory capabilities.

Enhancing Attachment Organization Among Maltreated Children: Results of a Randomized Clinical Trial

Young children who have experienced early adversity are at risk for developing disorganized attachments. The efficacy of Attachment and Biobehavioral Catch-up (ABC), an intervention targeting nurturing care among parents identified as being at risk for neglecting their young children, was evaluated through a randomized clinical trial. Attachment quality was assessed in the Strange Situation for 120 children between 11.7 and 31.9 months of age (M = 19.1, SD = 5.5). Children in the ABC intervention showed significantly lower rates of disorganized attachment (32%) and higher rates of secure attachment (52%) relative to the control intervention (57% and 33%, respectively). These results support the efficacy of the ABC intervention in enhancing attachment quality among parents at high risk for maltreatment.