Attachment and Biobehavioral Catch-up (ABC) Program

Type of services provided:

ABC, which is based on attachment theory and also stress neurobiology, has three core interventions. The first intervention, recognizing that children experiencing early trauma often behave in ways that push caregivers away, helps caregivers to re-interpret these behavioral signs and learn how to respond with nurturing care. The second intervention helps caregivers to learn how to provide a responsive, predictable environment that builds children’s behavioral and self-regulatory capacities. The third intervention component focuses on caregivers to help them recognize and change their own behaviors that can be overwhelming, frightening or triggering to a young child. A computer, videocamera and toys are needed for video-taping sessions.

Program setting:

Birth family home, adoptive home, foster/kinship care, shelters

Length of program/number of sessions:

10 weekly one-hour sessions

Type(s) of trauma/concerns addressed:

Neglect, abuse, domestic violence, placement instability

Symptoms addressed:

Three key issues addressed by ABC are: 1) child behaviors that push caregivers away; 2) a child that is dysregulated at behavioral and biological levels; and 3) caregiver behaviors that overwhelm or frighten a child.

Education level of providers:

Parent coaches who are screened to participate in a 2-3 day training and receive one year of supervision (there is no educational level requirement).

Unique/Innovative Characteristics:

Parent coaches use “In the Moment” comments to promote responsive caregiving, specifically parents’ ability to nurture their distressed child, follow their child’s lead, demonstrate delight in their child, and avoid frightening behaviors.

Has there been any evaluation?

Yes.

Key evaluation results:

ABC has been extensively evaluated. Some of the randomized clinical trial data are provided below. In a randomized clinical trial (Bernard et al, 2015) with children at risk for neglect who were involved with Child Protective Services, children receiving the ABC intervention showed more typical cortisol production, with higher wake-up cortisol levels and a steeper diurnal slope (morning to evening) than children receiving the control intervention (DEF: Developmental Education for Families).

In this same randomized clinical trial (Bernard et al, 2012) with parents identified as being at risk for neglecting their young children, children who received the ABC intervention had significantly lower rates of disorganized attachment (32%) and higher rates of attachment (52%) than children in the control intervention.

Children whose parents received ABC also showed better inhibitory control than children in the control condition, with fewer children touching prohibited toys than children in the control condition (Lind et al., 2017).

Parents in the ABC group show increases in sensitivity and decreases in intrusiveness relative to parents in the control condition (Yarger et al., 2016). The effect size for sensitivity changes is as large in community settings as in laboratory trials (Caron et al., 2016).

Is there an evaluation currently in progress or planned?

Yes. Also, examining the efficacy of neonatal intervention

Publications about the program:

Gaudreau, C., Delgado, A., Confair-Jones, R., Flambaum, S., Hirsh-Pasek, K., Raby, K. L., Dozier, M., & Golinkoff, R. M. (2024). The unanticipated side effects of an attachment intervention: Parents ask higher quality questions. Developmental Psychology, 60(3), 456–466. https://doi.org/10.1037/dev0001707

Korom, M., Valadez, E. A., Tottenham, N., Dozier, M., & Spielberg, J. M. (2024). Preliminary examination of the effects of an early parenting intervention on amygdala-orbitofrontal cortex resting-state functional connectivity among high-risk children: A randomized clinical trial. Development and Psychopathology, 1–9. doi:10.1017/S0954579423001669 

Labella, M. H., Raby, K. L., Bourne, S. V., Trahan, A. C., Katz, D., & Dozier, M. (2024). Is Attachment and Biobehavioral Catch-up effective for parents with insecure attachment states of mind? Child Development, 95(2), 648-655. https://doi.org/10.1111/cdev.14002 

Miller, K., Bourne, S., Dahl, C., Costello, C., Attinelly, J., Jennings, K., & Dozier, M. (2024). Using randomized controlled trials to ask questions regarding developmental psychopathology: A tribute to Dante Cicchetti. Development and Psychopathology, 1-10. https://doi.org/10.1017/S0954579424000245 

Valadez, E. A., Tottenham, N., Korom, M., Tabachnick, A. R., Pine, D. S., & Dozier, M. (2024). A randomized controlled trial of a parenting intervention during infancy alters amygdala-prefrontal circuitry in middle childhood. Journal of American Academy of Child and Adolescent Psychiatry, 63(1), 29-38.https://doi.org/10.1016/j.jaac.2023.06.015 

Tabachnick, A. R., Eiden, R. D., Labella, M. H., & Dozier, M. (2022). Effects of an attachment-based intervention on autonomic regulation among opioid-exposed infants. Developmental Psychobiology, 64, e22286. https://doi.org/10.1002/dev.22286

Yarger, H. A., Lind, T., Raby, K. L., Zajac, L., Wallin, A., & Dozier, M. (2022). Intervening with Attachment and Biobehavioral Catch-up to reduce behavior problems among children adopted internationally: Evidence from a randomized controlled trial. Child Maltreatment, 27, 478-489. doi.org/10.1177/10775595211010975

Korom, M., Goldstein, A., Tabachnick, A. R., Palmwood, E. N., Simons, R. F., & Dozier, M. (2021). Early parenting intervention accelerates inhibitory control development among CPS-involved children in middle childhood: A randomized clinical trial. Developmental Science, e13054. doi.org/10.1111/desc.13054

Lind, T., Raby, K. L., Goldstein, A., Bernard, K., Caron, E. B., Yarger, H. A., Wallin, A., & Dozier, M. (2021). Improving social-emotional competence in internationally adopted children with the Attachment and Biobehavioral Catch-up intervention. Development and Psychopathology, 33, 957-969. Doi:10.1017/S0954579420000255 

Raby, K. L., Waters, T. E. A., Tabachnick, A. R., Zajac, L., & Dozier, M. (2021). Increasing secure base script knowledge among parents with Attachment and Biobehavioral Catch-up. Development and Psychopathology, 33, 554-564. Doi: 10.1017/S0954579420001765 

Lind, T., Bernard, K., & Dozier, M. (2020). Promoting compliance in children referred to Child Protective Services: A randomized clinical trial. Child Development, 91, 563-576.

Raby, K. L., Bernard, K., Gordon, M. K., & Dozier, M. (2020). Enhancing diurnal cortisol regulation among young children adopted internationally. Development and Psychopathology, 32, 1657-1668.

Yarger, H. A., Bronfman, E., Carlson, E. A., & Dozier, M. (2020). Intervening with Attachment and Biobehavioral Catch-up to decrease disrupted parenting behavior and attachment disorganization: The role of parental withdrawal. Development and Psychopathology, 32, 1139-1148.

Yarger, H., Bernard, K., Caron, EB, Wallin, A., & Dozier, M. (2020). Enhancing parenting quality for young children adopted internationally: Results of a randomized controlled trial.  Journal of Clinical Child and Adolescent Psychology, 49, 378-390.

Valadez, E., A., Tottenham, N., Tabachnick, A. R., & Dozier, M. (2020). Early parenting intervention effects on brain responses to maternal cues among high-risk children. American Journal of Psychiatry, 177(9), 818-826. https://doi.org/10.1176/appi.ajp.2020.20010011

Zajac, L., Raby, K. L., & Dozier, M. (2020). Sustained effects on attachment security in middle childhood: Results from a randomized clinical trial of the Attachment and Biobehavioral Catch-Up (ABC) Intervention. Journal of Child Psychology and Psychiatry, 61(4), 417-424. https://doi.org/10.1111/jcpp.13146

Hoye, J. R., Cheishvili, D., Yarger, H. A., Roth, T. L., Szyf, M., & Dozier, M. (2019). Attachment and Biobehavioral Catch-up alters DNA methylation in maltreated children: Preliminary intervention effects from a randomized clinical trial. Development and Psychopathology, 32, 1486-1494. 

Raby, K. L., Freedman, E., Yarger, H. A., Lind, T., & Dozier, M. (2019). Enhancing the language development of toddlers in foster care by promoting foster parents’ sensitivity: Results from a randomized controlled trial. Developmental Science, 22(2), e12753. https://doi: 10.1111/desc.12753.

Tabachnick, A., Raby, K. L., Goldstein, A., Zajac, L., & Dozier, M. (2019). Effects of an attachment-based intervention on children’s autonomic regulation during middle childhood. Biological Psychology, 143, 22-31. https://doi.org/10.1016/j.biopsycho.2019.01.006

Rated/Reviewed by Evidence Based Registries:

SAMHSA’s National Evidence Based Practice Resource Center
California Evidence-Based Clearinghouse for Child Welfare
Maternal, Infant, and Early Childhood Home Visiting Program
National Child Traumatic Stress Network Empirically Supportive Treatments and Promising Practices