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Attachment and Biobehavioral Catch-up (ABC)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare Relevance Level:
High

See descriptions of 3 levels

Brief Description

The information in this program outline is provided by the program representative and edited by the CEBC staff. The Attachment and Biobehavioral Catch-up (ABC) program has been rated by the CEBC in the areas of: Infant and Toddler Mental Health (0-3) and Parent Training.

  • Type of Maltreatment: Physical Neglect
  • Target Population: Foster parents of infants.

ABC targets several key issues that have been identified as problematic among children who have experienced early maltreatment and/or disruptions in care. These young children often behave in ways that push caregivers away. The first intervention component helps caregivers to re-interpret children's behavioral signals so that they provide nurturance even when it is not elicited. Nurturance does not come naturally to many caregivers, but children who have experienced early adversity especially need nurturing care. Thus, the second intervention component helps caregivers provide nurturing care even if it does not come naturally. Third, many children who have experienced early adversity are dysregulated behaviorally and biologically. The third intervention component helps caregivers provide a responsive, predictable environment that enhances young children's behavioral and regulatory capabilities.

Essential Components

Three key, empirically defined issues are targeted through sessions that rely on video-feedback and homework. These issues include the following:

  • Child behaves in ways that push caregiver away. Caregiver helped to provide nurturance regardless.
  • Some caregivers may not be "naturally" nurturing. Caregiver helped to provide nurturance even though this may be at odds with usual tendencies.
  • Child is dysregulated at behavioral and biological levels. Caregiver helped to provide environment that helps child develop regulatory capabilities. (This includes parent following child's lead, showing delight in child, behaving in non-frightening way, and helping child recognize and express negative emotions.)

Child Component

Attachment and Biobehavioral Catch-up (ABC) was designed with a child component that addresses the following presenting problems and symptoms:

  • Children’s pushing caregivers away, children’s behavioral and biological dysregulation.

Age range: 0 – 5

Developmental Delays:

This program was not developed for children with developmental delays, and has not been tested for children with developmental delays.

Parent / Caregiver Component

Attachment and Biobehavioral Catch-up (ABC) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

  • Parents’ difficulty in providing nurturance, parents’ own history of care that may interfere with parenting.

Group Format

Attachment and Biobehavioral Catch-up (ABC) was not designed to be conducted in a group setting, and has not been tested for use in a group setting.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster Home

Homework

Attachment and Biobehavioral Catch-up (ABC) includes a homework component:

Parents make observations over the week and record observations. For most weeks, daily activities are suggested.

Languages

Attachment and Biobehavioral Catch-up (ABC) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

A/V:

  • Laptop computer
  • video camera
  • webcam

Personnel:

  • Clinician with excellent interpersonal skills.

Space:

  • Can be conducted at parents’ homes.

Minimum Provider Qualifications

No specific training or educational requirements for practitioners

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Training at University of Delaware with Supervision through videoconferencing.

Number of days/hours:

5 days training followed by 1 year supervision (weekly – 52 hours).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Dozier, M., Peloso, E., Lindheim, O., Gordon, M. K., Manni, M., Sepulveda, S., et. al. (2006). Developing evidence-based interventions for foster children: An example of a randomized clinical trial with infants and toddlers. Journal of Social Issues, 62(4), 767-785.

Type of Study: Randomized controlled trial
Number of Participants: 60, plus 104 comparison children not in foster care.

Population:

  • Age range — 3.6 months to 39.4 months at post-intervention
  • Race/Ethnicity — 63% African American, 32% White, 5% biracial
  • Gender — Not Specified
  • Status — Children in foster care

Location / Institution: Mid-Atlantic, U.S.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Children and caregivers were randomly assigned to receive either the Attachment and Biobehavioral Catchup (ABC) intervention or a control intervention, Developmental Education for Families (DEF), which focused on cognitive and language development. Salivary cortisol was used as a measure of stress level in children and infants. Parents also reported on problem behaviors using the pre-school or infant/toddler Parent's Daily Report (PDR/IT). Post-intervention cortisol levels were significantly lower for the ABC group than for the DEF group. The levels for children in the ABC group also did not differ from those of the normally developing group at the follow-up. Parents in the ABC group reported few problem behaviors for toddlers than for infants, but the ABC and DEF groups did not differ from each other on this measure.

Length of post-intervention follow-up: 1 month.

Dozier, M., Peloso, E., Lewis, E., Laurenceau, J., & Levine, S. (2008). Effects of an attachment based intervention on the cortisol production of infants and toddlers in foster care. Development and Psychopathology, 20, 845-859.

Type of Study: Randomized controlled trial
Number of Participants: 93, plus 48 children not in foster care.

Population:

  • Age range — 15 to 24 months
  • Race/Ethnicity — ABC: 38% African American, 1% Hispanic, 8% White; DEF: 31% African American, 2% Hispanic, 14% White.
  • Gender — Not Specified
  • Status — Children in foster care.

Location / Institution: University of Delaware

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Children and foster parents were randomly assigned to receive with the Attachment and Biobehavioral Catchup (ABC) intervention or to a comparison group which received the Developmental Education for Families (DEF) program which focuses on cognitive and language development. Stress was measured before and after exposure to the Strange Situation, a structured observational session which is designed to assess attachment level in young children. Salivary cortisol was used as the measure of stress level. Initial cortisol levels were higher for the DEF group than the ABC group, suggested a higher initial stress level. The initial cortisol levels of the ABC group did not differ from those of a comparison group of children from the general population. Measures of cortisol taken at subsequent points did not show any increase in cortisol levels in response to the Strange Situation for either treatment group, which is consistent with current research suggesting that children may experience a period of reduced cortisol response to stress. The authors suggest that collecting saliva samples prior to arrival at the laboratory might have produced a more accurate assessment of baseline levels of cortisol.

Length of post-intervention follow-up: None.

Dozier, M., Lindhiem, O., Lewis, E., Bick, J., Bernard, K., & Peloso, E. (2009). Effects of a foster parent training program on young children's attachment behaviors: Preliminary evidence from a randomized clinical trial. Child and Adolescent Social Work Journal, 26(4), 321-332. doi:10.1007/s10560-009-0165-1

Type of Study: Randomized controlled trial
Number of Participants: 46

Population:

  • Age range — 3.6 to 39.4 months
  • Race/Ethnicity — 63% African American, 26% White, 3% Hispanic, 7% biracial.
  • Gender — Not Specified
  • Status — Unknown.

Location / Institution: Unknown

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Children and foster parents were randomly assigned to either a group which received the Attachment and Biobehavioral Catchup (ABC) intervention or to a comparison group which received the Developmental Education for Families (DEF) program which focuses on cognitive and language development. Parents kept diaries of attachment related behavior (e.g., help-seeking behaviors) by children, their own behavioral response and infants' response to foster parents' behavior for a period of 3 days. Diaries were coded for proximity seeking, contact maintenance and successful calming to yield a score for secure. Also coded were avoidant behaviors including child anger, and inability to be soothed. Children in the ABC intervention condition had lower levels of avoidance than children in the DEF group. The two groups did not differ on security scores.

Length of post-intervention follow-up: None.

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(2), 623-636.

Type of Study: Randomized controlled trial
Number of Participants: 120

Population:

  • Age range — Child: 1.7-21.4 months. Parent: 15.7-47.0 years
  • Race/Ethnicity — Child: 61% African American, 20% Biracial, 11% White/Hispanic, and 8% White/non-Hispanic. Parent: 61% African American, 15% White/Hispanic, 15% White/non-Hispanic, and 9% Biracial.
  • Gender — Child: 58% Male and 42% Female. Parent: 98% Female and 2% Male
  • Status — Parents with Child Welfare involvement

Location / Institution: Large mid-Atlantic city

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study assessed the efficacy of Attachment and Biobehavioral Catch-up (ABC) through a randomized trial in which parents with Child Protective Services involvement were assigned to ABC or to a control intervention: Developmental Education for Families (DEF). Attachment quality was assessed for 120 children using the Strange Situation measure. Children in the ABC intervention showed significantly lower rates of disorganized attachment and higher rates of secure attachment relative to the control intervention. These results support the efficacy of the ABC intervention in enhancing attachment quality among parents at high risk formal treatment. Limitations include a lack of access to Child Protective Service records and use of Strange Situation Procedure beyond the age range for which it is validated.

Length of post-intervention follow-up: 1 month.

References

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

Dozier, M., Lindhiem, O., & Ackerman, J. (2005). Attachment and biobehavioral catch-up. In L. Berlin, Y. Ziv, L. Amaya-Jackson, & M. T. Greenberg (Eds.), Enhancing early attachments. New York: Guilford (pp. 178-194).

Lewis, E., Dozier, M., Knights, M., & Maier, M. (In press). Intervening with foster infants' foster parents: Attachment and biobehavioral catch-up. In R. E. Lee & J. Whiting (Eds.), Handbook of relational therapy for foster children and their families. Washington, DC: Child Welfare League of America.

Contact Information

Name: Mary Dozier, PhD
Agency/Affiliation: University of Delaware
Email:
Phone: (302) 831-8801
Fax: (302) 831-3645

Date Reviewed: March 2012 (originally reviewed in June 2008)