Attachment And Biobehavioral Catch-up 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).

Using randomized controlled trials to ask questions regarding developmental psychopathology: A tribute to Dante Cicchetti.

Dante Cicchetti, the architect of developmental psychopathology, has influenced so many of us in profound ways. One of his many contributions was in demonstrating the power of randomized controlled trials (RCTs) to study the effects of Child-Parent Psychotherapy (CPP). These RCTs have shed light on causal mechanisms in development. Following Cicchetti and colleagues' work, we designed a brief home visiting program, Attachment and Biobehavioral Catch-up (ABC), to help parents respond in sensitive, nurturing ways, so as to enhance children's attachment and self-regulatory capabilities. In the current study, we assessed adolescents' reports of the closeness of their relationships with their mothers 12 years after their mothers completed the intervention. A total of 142 adolescents participated (47 randomized to ABC, 45 randomized to a control intervention, and 50 from a low-risk comparison group). Adolescents whose mothers had been randomized to ABC reported closer relationships with their mothers than adolescents randomized to the control condition, with significant differences seen on approval, support, companionship, and emotional support subscales. Consistent with Cicchetti et al.'s work, these results provide powerful evidence of the long-term effects of an early parenting intervention.

Enhancing early parenting in the community: Preliminary results from a learning collaborative approach to scale up Attachment and Biobehavioral Catch-up.

Attachment and Biobehavioral Catch-up (ABC) is a promising home-visiting intervention promoting sensitive caregiving and secure parent-child attachment in families with young children. The goal of this study was to examine a learning collaborative approach to disseminating ABC in a community setting. Training outcomes (e.g., trainee completion, satisfaction, effectiveness of training methods) and intervention outcomes (e.g., parent behavior, parent beliefs, child socioemotional development) were examined. Eighteen practitioners participated in the ABC learning collaborative; 13 completed training. Quantitative and qualitative measures indicated that trainees were satisfied with their experience and valued the unique collaboration opportunities offered by the learning collaborative. In addition, trainees served 67 families in the community, 37 of whom completed all sessions of ABC. The study was conducted in the United States. Racial demographics of the children in the sample included: 56.7% White, 22.4% Black/African-American, 17.9% Bi- or Multi-racial, and 3.0% unknown. Regarding ethnicity, 80.6% were Non-Hispanic/Latino, 10.4% were Hispanic/Latino, and 9.0% were unknown. Caregivers who completed ABC showed more sensitive parenting behavior and reported positive changes in their perceived self-efficacy and their beliefs around infant crying. Children who received ABC showed increased socioemotional functioning. Results demonstrate successful dissemination of ABC in the community using a learning collaborative approach.

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.

Adapting Attachment and Biobehavioral Catch-up for infants and young children with intellectual disabilities and developmental delays in South Africa: Reflections and recommendations from local stakeholders.

Attachment and Biobehavioral Catch-up (ABC) is an intervention targeted at enhancing the socioemotional and regulatory functioning of at-risk infants. However, to use the ABC for infants/toddlers with intellectual disabilities/developmental delays (ID/DD) and in novel cultural contexts, such as South Africa, adaptations may be required. This study aimed, therefore, to explore the opinions of clinical experts and perceptions of caregivers regarding the use of ABC for children with ID/DD in South Africa. It also sought to incorporate the experiences of families of children with ID/DD who received, and intervenors who delivered, ABC in its first implementation in South Africa. Semi-structured interviews were conducted with 18 participants. Thematic analysis explicated 12 main themes: Intervention Strengths, Points of Concern, and Recommendations (Experts); Focus on Caregiver-child Relationship, and Intervention Targets and Duration (Caregivers); Benefits of ABC, and Cultural Considerations (ABC Recipients); Focused and Targeted, Value of Feedback, Supportive Supervision, Working Alliance, and Challenges Experienced (ABC Intervenors). Practice and training recommendations include psychoeducation for parents and training for intervenors that is ID/DD-specific, expanding supervision capacity, building intervenors' cultural/linguistic sensitivity and competence, accessing referral networks, including local Community Health Workers as intervenors, and greater flexibility in how the sessions are organized.

Transporting attachment and biobehavioral catch‐up to Norwegian child welfare services: A feasibility study

AbstractTransportation of evidence‐based programs (EBPs) to a new cultural setting is often preferred over the comprehensive process of developing a new program. Intervention fidelity has been suggested as a predictor of successful transportation. The present study examined whether fidelity and parent behavior improved when implementing the U.S.‐developed Attachment and Biobehavioral Catch‐up (ABC) intervention in Norwegian child welfare services (CWS). 11 child welfare workers received training and supervision to become ABC parent coaches. Fidelity was assessed through video‐recordings of parent coaches' in vivo feedback at each home‐visit session. Parent sensitive behavior was assessed using video‐recordings of parent–child interactions, recorded before each ABC session. Mixed effects modeling showed that ABC fidelity increased over the course of training and supervision. Furthermore, parent behavior improved over the course of families' exposure to the intervention. These demonstrate that an EBP transported to a novel cultural setting can obtain promising levels of fidelity and intervention outcomes.

Implementing attachment and biobehavioral catch-up in Norway: experiences from CWS parents, clinicians and leaders

ABSTRACT There is a pressing need in the Nordic countries for evidence-based programmes for young children who have experienced early adversity. One such programme, Attachment and Biobehavioral Catch-up (ABC) was implemented in seven Norwegian child welfare services (CWS). The aim of this study was to interview families, CWS workers and their leaders to explore their experiences in implementing ABC and to make recommendations for future use. Semi-structured interviews were conducted with 10 parents, 11 parent coaches and eight CWS leaders. Data were analysed using the framework method. The findings showed that ABC’s core elements such as in-vivo commenting and video feedback, were considered important for bringing about change. The intervention’s strengths-based approach helped reduce parents’ resistance towards coaches and strengthen the therapeutic relationship. There were diverging perspectives regarding the duration of the intervention, though most agreed on the need to make adaptations to suit the needs of individual families. Coaches viewed ABC as a welcoming addition to their service, due to the lack of interventions for infants in the CWS, although an expanded age limit would enable the recruitment of more families. Recommendations for future implementation include addressing recruitment and how to address issues outside the scope of ABC sessions.

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.

Assessing Changes in Parent Sensitivity in Telehealth and Hybrid Implementation of Attachment and Biobehavioral Catch-Up During the COVID-19 Pandemic.

During the COVID-19 pandemic, home visiting services for families with young children pivoted to continue providing services virtually. One such service was Attachment and Biobehavioral Catch-up (ABC), a brief prevention/intervention program targeting increased parental sensitivity. 70 families participated in a sensitivity assessment before and after receiving ABC. Forty-three families received the program fully through telehealth, and 27 families received the program through an in-person/telehealth hybrid format. Parent sensitivity was assessed pre- and post-intervention, and results suggested that when ABC was delivered through a telehealth or hybrid format, parents showed increased following the lead and decreased intrusiveness from pre- to post-intervention, with moderate effect sizes. Ongoing supervision in the model, weekly fidelity maintenance checks, and the flexibility of families and parent coaches likely contributed to the maintenance of significant change in parental sensitivity from pre- to post-intervention during the move from face-to-face home visiting to the provision of virtual services.

Transitioning to telehealth due to COVID-19: Maintaining model fidelity in a home visiting program for parents of vulnerable infants.

Maintaining treatment fidelity when implementing evidence‐based interventions is a significant challenge. The inability to deliver in‐person services due to the COVID‐19 pandemic critically challenged the foundation of implementation fidelity for home visiting programs across the globe. The Attachment and Biobehavioral Catch‐Up (ABC) program is an evidence‐based home visiting intervention designed to increase sensitivity in parents of infants who have experienced early adversity. ABC's community effectiveness is due to rigorous fidelity monitoring and supervision. Fidelity is measured by microanalytic coding of parenting opportunities and “in‐the‐moment” commenting, the active ingredient of ABC. In this study, we examined intervention fidelity among parent coaches implementing ABC through telehealth. Random 5‐min clips from 510 telehealth ABC session videos conducted by 91 parent coaches at 48 agencies were coded for their frequency and quality of in‐the‐moment comments. On average, parent coaches were able to exceed in‐person commenting fidelity standards when implementing ABC through the telehealth format. The active fidelity monitoring and supervision inherent to ABC's dissemination afforded a smooth transition to implementing ABC through telehealth while adhering to fidelity standards. Procedural and clinical challenges to telehealth implementation are discussed, along with future directions for telehealth program effectiveness.

Navigating the international dissemination of an evidence-based intervention: Scaling with fidelity and cultural-specificity

Attachment and Biobehavioral Catch-up (ABC), an evidence-based parenting program, monitors intervention fidelity and provides fidelity-focused supervision to providers, or “parent coaches,“ across one year of training. Recently, ABC dissemination has grown internationally, providing the opportunity for the ABC developer team to consider how to support intervention fidelity in an international context. The current manuscript describes early international dissemination efforts with local supervisors in Russia, Germany, and Norway. As part of ABC implementation, supervisors were trained in the in-the-moment commenting and coding system, a microanalytic behavioral coding system that measures fidelity to ABC. Local supervisors were also trained to provide fidelity-focused supervision. The present study found that supervisors were able to achieve coding reliability after engaging in an intensive week-long training, with reliability scores similar to supervisors who had gone through coding training in the United States. Supervisors were then able to deliver fidelity-focused supervision in the parent coaches’ native language, without the need to include an ABC staff member during the supervision meetings or provide translation of their behavioral coding. At the end of their training year, on average, parent coaches in the Russian, German, and Norwegian cohorts all met the fidelity requirements to gain certification in ABC, with fidelity data similar to those of parent coaches delivering ABC in the United States. Results from this evaluation demonstrate that an evidence-based parenting program with rigorous fidelity monitoring can be successfully transported from the United States to international contexts, with ongoing communication and collaboration between the developer site and international partners around language, culture, and fidelity-focused consultation as a key component of this dissemination.

38.4 CONSIDERING THE ROLE OF INTERGENERATIONAL TRAUMA

The objective of this presentation is to increase clinician awareness about the intergenerational transmission of childhood maltreatment (including potential mechanisms), child behavioral and mental health outcomes, psychotherapeutic interventions, and changes to interventions during the COVID-19 pandemic. This presentation will review the mechanisms of intergenerational transmission, common behavioral outcomes associated with a maternal history of exposure to childhood maltreatment, and changes in therapeutic interventions during the pandemic. There is growing evidence that the effects of childhood maltreatment are not limited to a single individual and may be transmitted across generations, increasing the risk for behavioral and mental health disorders in offspring. We will review potential mechanisms for mental health disorders in children and adolescents associated with a maternal history of exposure to childhood maltreatment. We will briefly examine less-established therapeutic interventions for children and families such as mindfulness-based cognitive therapy (MBCT), Attachment and Biobehavioral Catch-up (ABC), and Circle of Security. Special attention will be given to adaptations that have been successfully employed during the COVID-19 pandemic. Understanding the potential mechanisms and outcomes associated with the intergenerational transmission of childhood maltreatment will aid child and adolescent psychiatrists in identifying interventions and developing appropriate treatment plans that address broader aspects of maltreatment, therefore leading to improved outcomes.

Self-Coding of Fidelity as a Potential Active Ingredient of Consultation to Improve Clinicians' Fidelity.

A key goal for implementation science is the identification of evidence-based consultation protocols and the active ingredients within these protocols that drive clinician behavior change. The current study examined clinicians' self-coding of fidelity as a potential active ingredient of consultation for the Attachment and Biobehavioral Catch-up (ABC) intervention. It also examined two other potential predictors of clinician fidelity in response to consultation: dosage of consultation and working alliance. Twenty-nine clinicians (97% female, 62% White, M age = 34years) participated in a year of weekly fidelity-focused ABC consultation sessions, for which clinicians self-coded fidelity and received consultant feedback on both their coding and their fidelity. Data from the ABC fidelity measure were available for 1067 sessions coded by consultants, and clinicians' self-coding accuracy was calculated from 1044 sessions coded by both clinicians and consultants. Alliance was measured with the Working Alliance Inventory-Trainee and Supervisor Versions. The study was observational, and fidelity and self-coding accuracy were modeled across time using hierarchical linear modeling. Clinicians' ABC fidelity, as well as their self-coding accuracy, increased over the course of consultation. Clinicians' self-coding accuracy predicted their initial fidelity and growth in fidelity. Working alliance was also linked to fidelity and self-coding accuracy. These results suggest that clinician self-coding should be further examined as an active ingredient of consultation. The study has important implications for the design of consultation procedures and fidelity assessments.

Maternal Psychological Risk Moderates the Impacts of Attachment-Based Intervention on Mother-Toddler Mutuality and Toddler Behavior Problems: A Randomized Controlled Trial.

Although there is robust evidence of the benefits of attachment-based parenting interventions, limited research has examined their impact on dyadic mutuality and toddler behavior problems. Given the central question in prevention research of what works for whom, and the documented relation of maternal psychological risk to parenting and intervention response, it is important to consider the moderating role of maternal psychological risk in the efficacy of attachment-based interventions. The current study extends prior research on a randomized controlled trial of Attachment and Biobehavioral Catch-up (ABC) by examining its impact on dyadic mutuality and the moderating role of maternal psychological risk in ABC's impact on dyadic mutuality and toddler behavior problems. ABC (10 sessions) was provided as a supplement to Early Head Start (EHS) for a sample of predominantly low-income Latinx families. Control families received home-based EHS plus 1 book per week for 10weeks. We administered a psychosocial interview and video-recorded parent-toddler interaction pre- and post-intervention. Using intent-to-treat analyses, we found main effects of ABC on dyadic mutuality. We conducted latent class analysis to identify patterns of interrelationships among indicators of baseline maternal risk exposure to characterize a latent risk factor and used this factor to examine the moderating role of maternal psychological risk in ABC's impact on dyadic mutuality and toddler behavior problems. ABC seemed to be particularly beneficial for the development of positive, synchronous dyadic interactions and for reduction of toddler behavior problems in higher-risk EHS families. Findings are discussed in the context of designing and evaluating preventive interventions, with a specific focus on families at psychological risk.

Adapting an Evidence-Based Home Visiting Intervention for Mothers With Opioid Dependence: Modified Attachment and Biobehavioral Catch-up.

Infants born to mothers who are dependent on opioids often have difficulty regulating behavior and physiology at birth. Without sensitive maternal care, these infants are at risk for ongoing problems with self-regulation. Mothers who are dependent on opioids may experience challenges related to their substance use (e.g., unsupportive and/or risky environment, impulse control and reward system problems) that increase the likelihood of insensitive parenting in the absence of effective intervention. In this paper, we describe a home-visiting intervention we have adapted to enhance sensitive, responsive caregiving tailored to the specific needs of mothers with opioid dependence. The original intervention, Attachment and Biobehavioral Catch-up (ABC), was designed for mothers of infants aged 6–24 months who were exposed to early adversity. ABC has been shown to enhance sensitive parenting as well as children's behavioral and biological functioning, with positive outcomes extending into at least middle childhood. Mothers who are opioid dependent need earlier support than provided by ABC because opioid-exposed infants are often vulnerable at birth. The adapted intervention (modified ABC or mABC) includes one prenatal session and one early postnatal session, followed by 10 sessions every 2–3 weeks. In the initial two sessions in particular, mothers are helped to anticipate the challenges of caring for a baby who may be difficult to soothe while nonetheless providing sensitive care. mABC is intended to help mothers see the importance of responding sensitively so as to help infants overcome the developmental risks associated with opioid exposure. Additionally, mABC is structured to support mothers with the challenges of early parenting, especially if the mother herself was not parented sensitively. Throughout, the focus is on helping the mother nurture the distressed infant, attend to the infant's signals, and avoid behaving in overstimulating or intrusive ways. Case examples are presented that highlight both the challenges of working with this population as well as the gains made by mothers.

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.

A narrative review of mental and relational health interventions for children in family‐based out‐of‐home care

AbstractThe present article reviews the evidence base for psychosocial interventions provided to children in family‐based out‐of‐home care that seek to improve children’s mental health, felt security, and/or the quality, strength or permanence of their attachment relationships. The review identified very few high‐quality treatment trials carried out with this population. The interventions with the strongest demonstrated efficacy are Keeping Foster Parents Trained and Supported (KEEP) and Attachment and Biobehavioral Catchup (ABC). KEEP’s effectiveness has also been demonstrated in a community setting. Complex attachment‐ and trauma‐related difficulties manifested by children in care following early maltreatment follow a long‐term developmental course and have trait‐like durability. Treatment trials should be designed as long‐term studies, providing at least several years of post‐treatment assessment.Practitioner points Very few high‐quality intervention trials have been conducted with children and adolescents in out‐of‐home care and/or their caregivers. The interventions with the strongest demonstrated efficacy are Keeping Foster Parents Trained and Supported (KEEP) and Attachment and Biobehavioral Catchup (ABC). Given the enduring nature of complex trauma‐ and attachment‐related problems, treatment trials should include long‐term follow‐up mental health and relational measures. The effectiveness of treatments administered directly to adolescents are moderated by caregiver involvement and ‘buy‐in’.

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.

The importance of responsive parenting for vulnerable infants.

The quality of the early caregiving context sets the stage for the developing child's long term developmental trajectory. Infants are born highly dependent on parents and other caregivers for critical input for developing brain and behavioral systems. When infants experience early adversity, they are at risk for difficulties regulating behavior, emotions, and physiology. Parenting interventions have been developed to enhance parental responsiveness, thereby enhancing child outcomes. One such program, Attachment and Biobehavioral Catch-up (ABC), is a home visiting intervention designed to enhance parenting nurturance and sensitivity. In this paper, we will consider the importance of parental sensitivity and developmental consequences of sensitive and insensitive care. We will then describe interventions that target parental responsiveness and intervention effectiveness, focusing primarily on ABC. Public policy recommendations related to the importance of parental responsiveness will then be discussed.