Feature Article

Attachment and Biobehavioral Catch-Up Intervention

2019 Urie Bronfenbrenner Award Winner Mary Dozier describes her work on the ABC Intervention and its effects on children’s behavior and biology.
By Mary Dozier, PhD

Young children who have experienced early adversity often have difficulty developing adequate self-regulatory capabilities and secure, organized attachments. Our work has focused on understanding the specific problems faced by such children and designing parenting interventions that target the issues. We have worked with children in the child welfare system who live with their birth parents, children who live with foster parents and children who are adopted internationally following institutional care. With each of these groups, we have conducted randomized clinical trials in the lab and then made the intervention available nationally and internationally to others.

The Attachment and Biobehavioral Catch-up (ABC) intervention targets three parenting behaviors, each because of a need identified through research findings. First, young children who have experienced adversity are often dysregulated behaviorally and biologically. To enhance children’s self-regulation, parents are coached to follow their children’s lead. Following-the-lead interactions are experienced as very smooth and controllable, which enhance children’s attention and regulation (Raver, 1996). Parent coaches make “in-the-moment” comments that support parents following their children’s lead. Comments are almost entirely positive, bringing attention to very specific ways that parents are following their children’s lead. Such comments often lead to a cascade of sensitive behaviors on the parent’s part. More frequent comments are related to greater change in parental sensitivity (Caron, Bernard, & Dozier, 2016).

Second, young children who have experienced adversity especially need nurturing care. Without nurturing care, they are at risk for developing disorganized attachments (Dozier, Stovall, Albus, & Bates, 2001). In addition to providing a rationale for the importance of nurturing parenting based on research findings, ABC parent coaches make in-the-moment comments when parents behave in nurturing ways. As with in-the-moment comments about following the lead, these comments provide real-time feedback that describe nurturing parenting behaviors and link the behaviors with long-term child outcomes.

Third, parents living under challenging conditions are often frightening or harsh in their interactions with their children. Frightening parental behavior undermines children’s ability to develop self-regulatory capabilities and the ability to develop organized attachments (Schuengel, Bakermans-Kranenburg, & van IJzendoorn, 1999). ABC helps parents recognize when they are behaving in potentially frightening ways and to appreciate how these behaviors affect their children.

We have assessed the efficacy of the ABC intervention through randomized, controlled trials and found striking and lasting effects on children’s behavioral and biological outcomes. Children whose parents received the ABC intervention develop secure and organized attachments more often than children whose parents received a control intervention (Bernard, Dozier, Bick, Lewis-Morrarty, Lindhiem, & Carlson, 2012). Diurnal cortisol production is more normative among children in the ABC group than in the control group (Bernard, Dozier, Bick, & Gordon, 2015), with effects seen though early and middle childhood (e.g., Bernard, Hostinar, & Dozier, 2015). Effects are also seen on executive functioning, language development, DNA methylation, brain activation and autonomic nervous system regulation (e.g., Tabachnick, Zajac, Goldstein, Raby, & Dozier, in press).

Having developed an intervention with a strong evidence base, disseminating the intervention in the community may seem straightforward. What has become painfully clear over the last several decades, however, is that moving an intervention from a research lab into the community is not easy. One of the things that often goes wrong is that interventions are not implemented with adequate fidelity to the model when implemented in the community (Santa Ana et al., 2008). Based on what we knew from the literature and our early experiences with challenges in implementing with fidelity, we (Caron et al., 2016) developed a micro-analytic system for monitoring fidelity. Using only a five-minute clip from a session each week, parent coaches’ in-the-moment comments can be reliably monitored. Throughout their year of supervision on the ABC model, parent coaches implementing ABC around the world therefore get quantified feedback weekly regarding the extent to which they are meeting criteria. We think that this attention to fidelity is why we find effect sizes in the community that are as large as effects found through randomized clinical trials (Roben, Dozier, Caron, & Bernard, 2017).

This work has been challenging and exciting. We look forward to adapting this intervention for use with other populations (e.g., for opioid-dependent mothers), to integrating with other services and to exploring intervention effects even beyond middle childhood. We were surprised that the intervention has proven so successful with effects sustained over many years. I am honored, on behalf of my collaborators and students, to have been chosen as the Urie Bronfenbrenner Awardee for Lifetime Contribution to Developmental Psychology in the Service of Science and Society.

References

Bernard, K., Dozier, M., Bick, J., Lewis-Morrarty, E., Lindhiem, O., & Carlson, E. (2012). Enhancing attachment organization among maltreated infants: Results of a randomized clinical trial. Child Development, 83, 623-636.

Bernard, K., Hostinar, C. E., & Dozier, M. (2015). 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, 169, 112-119.

Bernard, K., Dozier, M., Bick, J., & Gordon, M. K. (2015). Intervening to enhance cortisol regulation among children at risk for neglect: Results of a randomized clinical trial. Development and Psychopathology, 27, 829-841.

Caron, E., Bernard, K., & Dozier, M. (2016). In-vivo feedback predicts behavioral change in the Attachment and Biobehavioral Catch-up Intervention. Journal of Clinical Child and Adolescent Psychology.

Dozier, M., Stovall, K. C., Albus, K. E., Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child Development, 72, 1467-1477

Raver, C. C. (1996). Relations between social contingency in mother-child interactions and 2-year-olds' social competence. Developmental Psychology, 32, 850-859.

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

Santa Ana, E. J., Martino, S., Ball, S. A., Nich, C., Frankforter, T. L., & Carroll, K. M. (2008). What is usual about "treatment-as-usual"? Data from two multisite effectiveness trials. Journal of Substance Abuse Treatment, 35, 366-379.

Schuengel, C., Bakermans-Kranenburg, M. J., & van IJzendoorn, M H. (1999). Frightening maternal behavior linking unresolved loss and disorganized infant attachment. Journal of Consulting and Clinical Psychology, 67, 54–63

Tabachnick, A., Zajac, L, Goldstein, A., Raby, K. L., & Dozier, M. (In press). Effects of an attachment-based intervention on children's autonomic regulation during middle childhood. Biological Psychology.

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