Attachment and Biobehavioral Catch-up (ABC) - Promising Futures

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).

Additional information:

None

Unique/Innovative Characteristics:

In-home, skill-building intervention with caregivers that is led by parent coaches. Parent coaches use of “In the Moment” comments to target caregivers’ behaviors for nurturance, following a child’s lead, delight and non-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 efficacy of toddler intervention, and effectiveness trials of infancy intervention

Publications about the program:

Evaluation studies referenced here:

Bernard K, Dozier M, Bick J, Gordon MK. Intervening to enhance cortisol regulation among children at risk for neglect: Results of a randomized controlled trial. Developmental Psychopathology. 2015;27(3):829-41.

Bernard K, Dozier M, Bick J, Lewis-Morrarty E, Lindheim O, Carlson E. Enhancing attachment organization among maltreated children: results of a randomized clinical trial. Child Development. 2012;83(2):623-36.

Caron, E., Weston-Lee, P., Haggerty, D., & Dozier, M. Community implementation outcomes of Attachment and Biobehavioral Catch-up. Child Abuse and Neglect. 2016;53:128-137.

Additional references provided by the program contact include:

Bernard, K., Lee, A. H., & Dozier, M. Effects of the ABC Intervention on foster children’s receptive vocabulary: Results from a randomized clinical trial. Child Maltreatment. 2017;22:174-179.

Bernard, K., Hostinar, C. E., & Dozier, M. Intervention effects on diurnal cortisol rhythms of CPS-referred infants persist into early childhood: Preschool follow-up results of a randomized clinical trial. JAMA-Pediatrics.2015;169: 112-119.

Bernard, K., Simons, R. F., & Dozier, M. Effects of an attachment-based intervention on high-risk mothers’ event related potentials to children’s emotions. Child Development. 2015; 86:1673-1684.

Bernard, K., Meade, E., & Dozier, M. Parental synchrony and nurturance as targets in an attachment based intervention: Building upon Mary Ainsworth’s insights about mother-infant interaction. Attachment and Human Development. 2014;15:507-523.

Bick, J., Dozier, M. The effectiveness of an attachment-based intervention in promoting foster mothers’ sensitivity toward foster infants. Infant Mental Health Journal. 2013;34:95-103.

Dozier, M., & Bernard, K. Attachment and Biobehavioral Catch-up: Addressing the needs of infants and toddlers exposed to inadequate or problematic caregiving. Current Opinion in Psychology. 2017;15:111-117.

Dozier M, Dozier D, Manni M. Recognizing the special needs of infants’ and toddlers’ foster parents: Development of a relational intervention. Zero to Three Bulletin. 2002;22:7-13.

Lewis-Morrarty, E., Dozier, M., Bernard, K., Moore, S., & Terraciano, S. Cognitive flexibility and theory of mind outcomes among foster children: Preschool follow-up results of a randomized clinical trial. Journal of Adolescent Health. 2012;51:17-22.

Lind, T., Raby, L., & Dozier, M. Attachment and Biobehavioral Catch-up effects on foster toddler executive functioning: Results of a randomized clinical trial. Development and Psychopathology. 2017;29:575-586.

Lind, T., Bernard, K., Ross, E., & Dozier, M. Intervention effects on negative affect of CPS-referred children: Results of a randomized clinical trial. Child Abuse and Neglect. 2014;38:1459-1467.

Meade, EB, Dozier, M., & Bernard, K., Using video feedback as a tool in training parent coaches: Promising results from a single-case design. Attachment and Human Development. 2014;16:356-370.

Roben, C. K. P., Dozier, M., Caron, E, & Bernard, K. Moving an evidence-based parenting program into the community. Child Development. 2017;88:1447-1452.

Yarger, H., Hoye, J., & Dozier, M. Trajectories of change in Attachment and Biobehavioral Catch-up among high-risk mothers: A randomized clinical trial. Infant Mental Health Journal. 2016;37:525-536.

Rated/Reviewed by Evidence Based Registries:

SAMHSA’s National Evidence Based Practice Resource Center
California Evidence-Based Clearinghouse for Child Welfare
National Child Traumatic Stress Network Empirically Supportive Treatments and Promising Practices