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Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC)

Topic Areas
Scientific Rating
Child Welfare Relevance
Home Visiting Programs for Child Well-Being
3  — Promising Research Evidence
High
Infant and Early Childhood Mental Health (Birth to 5)
3  — Promising Research Evidence
High

About This Program

Target Population: Caregivers of young children ages 2 through 4 who have experienced early adversity or are demonstrating socioemotional or behavioral concerns

For children/adolescents ages: 2 – 4

For parents/caregivers of children ages: 2 – 4

Program Overview

Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC), developed for children ages 2 through 4, targets several key issues that have been identified as problematic among children who have experienced adversity and/or demonstrate socioemotional or behavioral concerns. These young children often behave in ways that push caregivers away. The first intervention component is designed to help caregivers reinterpret 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 adversity especially need nurturing care. Thus, the intervention aims to help caregivers provide nurturing care even if it does not come naturally. Second, many children who have experienced adversity are dysregulated behaviorally and biologically. The second intervention component is designed to help caregivers provide a responsive, predictable, warm environment that enhances young children's behavioral and regulatory capabilities. The intervention aims to help caregivers follow their children's lead with delight. The third intervention component is designed to help caregivers implement calming strategies and be present psychologically and physically when their child is dysregulated.

Program Goals

The goals of Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC) are:

For caregivers:

  • Increase nurturance
  • Increase sensitivity
  • Increase delight
  • Increase calming behaviors

For children:

  • Increase attachment security
  • Decrease disorganized attachment
  • Increase behavioral regulation
  • Increase emotional regulation
  • Increase biological regulation

Logic Model

The program representative did not provide information about a Logic Model for Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC).

Essential Components

The essential components of Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC) include:

  • ABC-EC targets three key issues:
    • Child behaves in ways that push caregiver away:
      • Caregiver taught how to override tendencies to respond in kind and provide nurturance regardless.
    • Child dysregulated at behavioral and biological levels:
      • Caregiver helped to provide environment that helps child develop regulatory capabilities. This includes the caregiver:
        • Following child's lead
        • Showing delight in child
      • Caregiver taught how to:
        • Calm child when they are dysregulated
        • Stay psychologically and physically available
    • Program characteristics:
      • Parent coaches conduct home visit sessions with the family’s caregiver(s) and child(ren) where they:
        • Use in-the-moment comments that target the caregiver behaviors of nurturance
        • Teach how to lead with delight
        • Teach calming strategies
        • Manualized intervention
        • Video-feedback
        • Homework
      • Delivery:
        • In-person in families’ homes
        • Via telehealth

Program Delivery

Child/Adolescent Services

Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC) directly provides services to children/adolescents and addresses the following:

  • Challenges related to adversity and socioemotional and behavioral concerns

Parent/Caregiver Services

Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC) directly provides services to parents/caregivers and addresses the following:

  • Have children who have experienced adversity and/or are demonstrating socioemotional and behavioral concerns
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Any child or parent/caregiver living in the residential setting are invited to participate in ABC-EC sessions.

Recommended Intensity:

Weekly one-hour sessions

Recommended Duration:

10 weeks

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • Shelter (Domestic Violence, Homeless, etc.)
  • Virtual (Online, Smartphone, Zoom, Telephone, Video, etc.)

Homework

Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC) 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 - Early Childhood (ABC-EC) has materials available in languages other than English:

German, Mandarin, Norwegian, Russian, Spanish, Swedish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Audiovisual Needs:

  • Laptop computer
  • Video camera
  • Webcam for supervision

Personnel:

  • Clinician with excellent interpersonal skills

Space:

  • ABC-EC is typically conducted at caregivers' homes; this can include shelters or other temporary living situations
  • If ABC-EC is conducted via telehealth (and families are participating from their homes), the clinician will need a private and confidential space to conduct virtual sessions.

Miscellaneous:

  • Age-appropriate toys (e.g., toys, blocks)

Manuals and Training

Prerequisite/Minimum Provider Qualifications

There is no educational level requirement for parent coaches. Potential parent coaches participate in a screening prior to training. If they pass the short screening, they attend program training.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

  • Dozier, M., & the Attachment and Biobehavioral Catch-up Team. (2024). Attachment and Biobehavioral Catch-up for Early Childhood (ABC-EC). [Unpublished manuscript]. ABC Parenting Institute.

The ABC-EC manual is only available to parent coaches who receive training and supervision in the model.

Training Information

There is training available for this program.

Training Contacts:
Training Type/Location:

Training is held in-person or virtual. When trainings are held in-person, the location varies (e.g., at ABC Parenting headquarters in Newark, DE, or onsite at the trainee’s organization) by cohort needs.

Number of days/hours:

2 full days of in-person training or 3 half-days of virtual training to become a Parent Coach then followed by 6 months of supervision [1.5 hours weekly, including group supervision and individual supervision in in-the-moment (ITM) commenting] to become a Certified Parent Coach. If Parent Coaches are receiving supplemental training in another ABC model (e.g., ABC-Infant), the duration of training and the supervision period is extended.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC) as listed below:

A half-hour screening is used to predict which potential coaches are likely to be most successful. This screening is conducted remotely through video conferencing with potential coaches. After the screening, ABC Parenting Institute staff informs the parent coach (or their agency) about their suitability for training. This step is conducted before training.

Formal Support for Implementation

There is formal support available for implementation of Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC) as listed below:

Supervision is conducted for at least 6 months via video conferencing using Zoom (HIPAA-compliant video conference software that the program provides). Parent coach trainees have two required supervision meetings per week, General Clinical Supervision and in-the-moment (ITM) Commenting Supervision:

  • General Clinical supervision is 1-hour per week group supervision conducted in groups of 2 or 3, with an expert-level supervisor. Supervision includes video review each week.
  • In-the-moment (ITM) Commenting supervision is a 30-minute session per week conducted by staff members at ABC Parenting Institute. A 5-minute segment from the parent coach's case is assigned to the parent coach and staff member for coding prior to the supervision session. The supervision is directed at enhancing coding reliability (so that parent coaches will learn to identify triggers for comments and components of comments) and at enhancing comment quality and frequency.

After the supervision period, parent coaches' adherence and fidelity are evaluated for certification. If they pass, coaches are certified for two years. After two years, parent coaches can participate in a brief webinar and complete a quiz (which assesses adherence and fidelity) to become recertified at no cost.

Parent coaches also receive support in terms of program evaluation, which is required during the supervision period. Program evaluation measures include brief sensitivity assessments and parent/caregiver questionnaires before and after ABC.

Taken together, this formal support is intended to ensure treatment adherence, provide fidelity monitoring, and provide program evaluation efforts.

Fidelity Measures

There are fidelity measures for Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC) as listed below:

Parent coaches are reviewed for both their adherence and their fidelity to the model. Parent coaches are measured on their adherence to manual content and general clinical issues. For treatment adherence, there is a short list of specific issues from each session that are to be covered from manual content. For treatment fidelity, a parent coach's frequency and quality level of "in-the-moment” commenting is monitored and tracked each week in addition to a qualitative review

Fidelity Measure Requirements:

Fidelity measures are required to be used as part of program implementation.

Established Psychometrics:

  • Caron, E., Bernard, K., & Dozier, M. (2018). In vivo feedback predicts behavioral change in the Attachment and Biobehavioral Catch-up Intervention. Journal of Clinical Child and Adolescent Psychology, 47, S35-S46. https://doi.org/10.1080/15374416.2016.1141359

Implementation Guides or Manuals

There are no implementation guides or manuals for Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC).

Implementation Cost

There are no studies of the costs of Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC).

Research on How to Implement the Program

Research has been conducted on how to implement Attachment and Biobehavioral Catch-up - Early Childhood (ABC-EC) as listed below:

  • Caron, E., Kipp, E. C., Costello, A. H., Bernard, K., Schein, S. S., Roben, C. K. P., & Dozier, M. (2022). Parent coaching fidelity trajectories of in-person and telehealth sessions during the COVID-19 Pandemic. Evidence-Based Practice in Child and Adolescent Mental Health, 7(3), 341–348. https://doi.org/10.1080/23794925.2021.1996300
  • Flagg, A., Costello, A., Roben, C. K. P., & Dozier, M. (2021). Changes in provider fidelity after introducing a new model of intervention. Current Psychology, 41, 3906–3915. https://doi.org/10.1007/s12144-020-00910-1
  • Schein, S. S., Roben, C. K. P., Costello, A. H., & Dozier, M. (2022). Assessing changes in parent sensitivity in telehealth and hybrid implementation of Attachment and Biobehavioral Catch-Up during the COVID-19 Pandemic. Child Maltreatment, 28(1), 24–33. https://doi.org/10.1177/10775595211072516

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Lind, T., Raby, K. L., Caron, E. B., Roben, C. K. P., & Dozier, M. (2017). Enhancing executive functioning among toddlers in foster care with an attachment-based intervention. Development and Psychopathology, 29(2), 575–586. https://doi.org/10.1017/S0954579417000190

Type of Study: Randomized controlled trial
Number of Participants: 173 parent–toddler dyads

Population:

  • Age — 14.5–56.3 months
  • Race/Ethnicity — 79 African American, 58 White, 18 Biracial, 14 Hispanic, and 4 Asian American
  • Gender — 89 Male and 84 Female
  • Status — Participants were young children involved in the foster care system.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy of the Attachment and Biobehavioral Catch-up for Toddlers (ABC-T) intervention [now called Attachment and Biobehavioral Catch-up (ABC) - Early Childhood] on enhancing executive functioning among young children in foster care. Participants were randomized to either ABC-T or to the Developmental Education for Families (DEF) control group and compared to a non-intervention non-foster family comparison group. Measures utilized include foster care history administrative data, the Child Behavior Checklist (CBCL), and the Dimensional Change Card Sort. Results indicate that foster children whose parents received the ABC-T intervention and low-risk children never placed in foster care had fewer parent-reported attention problems and demonstrated greater cognitive flexibility during the Dimensional Change Card Sort than foster children whose parents received the control intervention. Limitations include a lack of follow-up for the non-foster family comparison group.

Length of controlled postintervention follow-up: None.

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), Article e12753. https://doi.org/10.1111/desc.12753

Type of Study: Randomized controlled trial
Number of Participants: 88

Population:

  • Age — 24–26 months
  • Race/Ethnicity — 49% African American, 28% Caucasian, 15% Other, and 8% Hispanic
  • Gender — 49% Female
  • Status — Participants were young children in foster care.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate whether Attachment and Biobehavioral Catch-up for Toddlers (ABC-T) [now called Attachment and Biobehavioral Catch-up (ABC) - Early Childhood] improves the receptive vocabulary abilities of children in foster care and to also evaluate whether increases in foster parents’ sensitive caregiving represent the mechanism of change for improvements in foster children’s receptive vocabulary abilities. Participants were randomized to either ABC-T or the Developmental Education for Families (DEF) control group. Measures utilized include the Peabody Picture Vocabulary Test-Third Edition (PPVT), semi-structured recorded family interactions, and an adapted version of the Observational Record of the Caregiving Environment. Results indicate that children whose foster parents received ABC-T demonstrated more advanced receptive vocabulary abilities than children whose foster parents received the control intervention. The positive effect of ABC-T on foster children’s receptive vocabulary was mediated by increases in foster parents’ sensitivity during parent-child interactions. Limitations include lack of information about children’s receptive vocabulary abilities prior to random assignment to the interventions; high attrition at follow-up assessments; data regarding parental sensitivity were only available for one foster parent for each child; and lack of data on other aspects of children’s receptive language development, expressive language abilities, and language processing.

Length of controlled postintervention follow-up: Parent measure: 1 month and then varies by child age at baseline - 9.5 months, 21.5 months, and 33.5 months; Child measure: Varies by child age at baseline - 9.5 months, 21.5 months, and 33.5 months.

The following studies were not included in rating ABC-EC on the Scientific Rating Scale...

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 as higher quality questions. Developmental Psychology, 60(3), 456–466. https://doi.org/10.1037/dev0001707

The study used the same sample as Raby et al. (2019). The purpose of the study was to test whether Attachment and Biobehavioral Catch-up (ABC) [now called Attachment and Biobehavioral Catch-up (ABC) - Early Childhood] results in more conversational turns between parents and their children. Participants were randomized to either ABC or the Developmental Education for Families (DEF) control group. Measures utilized include videotapes and coding that analyzed parent-child conversational turns. Results indicate 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. Limitations include no baseline data, essentially no pretest was conducted to equate the ABC group and DEF group on vocabulary abilities or the quality of the conversations parents were having with their children; analyses did not control for total word count, as the full interaction was not transcribed; it is unknown if the ABC intervention caused linguistic changes as the study used a single time point in the design; and finally recordings of the parent– child interactions were relatively brief. Note: This article was not used in the rating process since it does not report baseline data.

Additional References

Dozier, M., & Bernard, K. (2017). Attachment and Biobehavioral Catch-up: Addressing the needs of infants and toddlers exposed to inadequate or problematic caregiving. Current Opinion in Psychology, 15, 111–117. https://doi.org/10.1016/j.copsyc.2017.03.003

Dozier, M., Roben, C. P., Caron, E., Hoye, J., & Bernard, K. (2018). Attachment and Biobehavioral Catch-up: An evidence-based intervention for vulnerable infants and their families. Psychotherapy Research, 28(1), 18–29. https://doi.org/10.1080/10503307.2016.1229873

Dozier, M., & Bernard, K. (2019). Coaching parents of vulnerable infants: The Attachment and Biobehavioral Catch-up approach. The Guilford Press. Available at this link.

Contact Information

Mary Dozier, PhD
Agency/Affiliation: Executive Director of ABC Parenting Institute
Website: www.abcparenting.org/aboutabc
Email:
Phone: (302) 405-5022
Lindsay Zajac, PhD
Agency/Affiliation: Managing Director of ABC Parenting Institute
Website: www.abcparenting.org/aboutabc
Email:
Phone: (302) 405-5022
Vinaya Rajan, PhD
Agency/Affiliation: Director of Training at ABC Parenting Institute
Website: www.abcparenting.org/aboutabc
Email:
Phone: (302) 405-5022
ABC Parenting Institute
Website: www.abcparenting.org/aboutabc
Email:

Date Research Evidence Last Reviewed by CEBC: February 2025

Date Program Content Last Reviewed by Program Staff: November 2024

Date Program Originally Loaded onto CEBC: August 2025