Intervening with Foster and High-Risk Families: Attachment and Biobehavioral Catch-up

1. Mary Dozier Infant-Caregiver Lab University of Delaware Many Paths to Enhancing Parent Child Relationships Orlando, Florida April 23, 2014 Intervening with Foster and High-Risk Families:Attachment and Biobehavioral Catch-up

2. Infant reliance on parent Temperature regulation Neuroendocrine regulation Protection from infection Protection from danger Contact comfort Security Please note that not all slides are included here. This will, though, provide a general outline to follow along if you would like.

3. Effects of Neglect on Health and Mental Health • Health • Growth; immune system functioning • Mental Health • Emotion regulation: Depression, Anxiety • Behavioral regulation: Conduct disorders, Substance use

4. Attachment and Biobehavioral Catch-up • 10- session intervention • Targets key issues identified as problematic for children who have experienced early adversity • Implemented in home

5. Attachment and Biobehavioral Catch-up Intervention • Adapted for • Foster parents of infants • Neglecting birth parents of infants • Foster parents of toddlers (2-3 year olds) • Parents adopting internationally • Visitation (birth parents and foster parents)

7. Children push parents away • Diary study over 60 days • What did child do? What did you do in response? • Infants older than 12 months or so did not show secure behaviors across period studied • Contingency analyses reveal that parents respond “in kind” • (Stovall-McClough & Dozier, 2004) Please note that this condenses several slides from the talk into one.

8. First intervention component:Re-interpreting child’s behavioral signals Your child may not appear to need you But, every child needs his or her parent • Need to re-interpret signals • Need to provide nurturance Task is tougher for high-risk birth, foster, and adoptive parent than for parents of children who have not experienced early adversity

9. Intervention strategies Help parents to change through: Issues raised through manual Video feedback In The Moment feedback

10. Biological dysregulation Early adversity leads to biological dysregulation Non-human and rodent (as well as human) studies have shown effects of early experience on HPA system

11. HPA system H - Hypothalamus P - Pituitary A – Adrenal Cortisol an end product Sensitive to effects of early experience

12. HPA system: 2 orthogonal functions • Stress reactive function • Body’s mounting a stress response • Diurnal function • Organism functioning as diurnal (or nocturnal) creature We (and many others) have found more action with diurnal function

13. When we measure cortisol mg/dl

14. Early Adversity and Diurnal Cortisol Bernard, Butzin-Dozier, Rittenhouse, & Dozier,2010

15. Dysregulation • Biological dysregulation: cortisol • Behavioral dysregulation: • Behavior problems • Inhibitory control

16. Second target for intervention: Helping children develop better regulatory capacities • Synchronous interactions predict better regulatory capabilities (Raver, 1996)

17. Frightening behavior Many parents behave in frightening ways • way to control behavior • response to distress • unaware (even dissociating)

18. Reduce frightening behavior • Make clear how parental behaviors can be overwhelming to child (e.g., tickling, teasing), followed by behaviors that are frankly frightening • Help parents notice those behaviors • Help parents see other choices

20. Assessing effectiveness Randomly assigned children and parents to ABC or to an alternate intervention (DEF) 120 children, half in ABC, half in DEF

21. Intervention Effects on Diurnal Cortisol Production

22. Attachment quality • Assessed in Strange Situation • N=120 • Breakdown significantly different for ABC and DEF • For disorganized vs. organized attachment • For secure vs. insecure attachment

23. Percentage Disorganized Attachment Among Children in ABC and DEF Interventions Bernard, Dozier et al., Child Development, 2012

24. Foster Toddlers • Preliminary data from Preschool Strange Situation • Intervention includes calming in addition to nurturance, synchrony, non-frightening behaviors

25. Percentage Secure Attachment Among Foster Children in ABC and DEF Interventions (Toddlers/Preschool SS)

26. Assessment of emotion expression • Assess emotion expression/regulation in challenging task • (Tool Task) • N=120

27. Negative Affect Among Children in ABC and DEF Interventions

28. Assessment of executive functions • Assess executive functions in Dimensional Change Card Sort (DCSS) • Foster children • (sort according to one dimension, then switch dimensions) • Assess number correct pre- and post-dimensional change

30. ABC Effects on Mother ERPs • Does mothers’processing of children’s emotional faces change as the result of ABC? • Compared 3 groups: • Low-risk comparison (n = 34) • High-risk control DEF intervention (n = 25) • High-risk ABC intervention (n = 24) Kristin Bernard dissertation

31. Attachment and Biobehavioral Catch-up • 10 session intervention • In home • In the moment comments • Most critical aspect

32. Why so important? • Supports parent • Rewarding, she feels supported, valued • Bring parent’s attention to specific behavior • She did x, you did x • Links behavior with intervention targets • That’s such a good example of …. • Links behavior with child outcomes • That will help her feel….

33. In the moment commenting • Every opportunity for nurturing or synchronous behavior is trigger for parent coach comment (up to 100+ in hour session) • Components of comments: • Describe behavior • Link to target • Link to child outcomes

34. Sessions • 1-2: Introduce intervention; Nurturance • 3-4:Following the lead • 5-6: Avoiding intrusive and frightening behaviors • 7-8: Parents’ own issues • 9-10: Consolidate gains

35. ABC • Evidenced based intervention • Effects on attachment, physiology, etc. • Uses in the moment commenting as central • Example of pre-intervention to montage

36. Acknowledgments • NIMH R01 52135, 84135, 74374 • Philadelphia DHS • Delaware DFS • Edna Bennett Pierce • Infant-Caregiver Lab