Back to List

Compare
Print Share

Attachment & Biobehavioral Catch-Up (ABC) Infant

Category

Family Support

Child's Age

0-1 years, 1-2 years

Participant

Children, Parents/Guardian

Languages

English, Spanish, German, Other

Brief Description

Attachment & Biobehavioral Catch-Up (ABC) Infant is a strengths-based parent/child home visiting model for families with children ages 6 months to 24 months. ABC Infant enhances the attachment security between a child and their caregiver, fosters strong, healthy relationships between parents and children, and promotes the child’s development.

Expected Impact

  • Fewer internalizing and externalizing behaviors than children in the control intervention group 
  • Fewer parent-reported symptoms of depression than parents in the control group
  • Greater parental sensitivity and positive regard than parents in the control intervention group
  • Higher rates of organized attachment and perceived attachment security than children in the intervention control group
  • Higher scores on the Peabody Picture Vocabulary Test when assessed at 2 years post-intervention, indicative of improved early language skill acquisition 
  • Less intrusiveness than parents in the control intervention group 
  • Lower levels of anger, avoidance when distressed, anger toward parents, global anger, sadness, and negative affect expression than children in the control intervention group
  • Stronger cortisol regulation patterns than children in the intervention control group

Core Components for Model Fidelity

  • Sessions: 10 weekly sessions of 60-75 minutes each following a manual with specific topics to be covered based on the session. 
  • “In the Moment” Commenting (monitored by model purveyor): Parent Coaches must comment on what the parent is doing well while observing parent and child interactions at least once per minute (known as “In the Moment” (ITM) commenting). The comments must cover instances when the parent is following the child's lead with delight and paying attention to the child's cues. ITM comments must have at least 1 of 3 components:
    • Labels what the parent is doing
    • Describes what the parent is doing
    • Shares how what the parent is doing will impact the child in the future
  • Video of Session: The Parent Coach takes a video recording of the whole session to clip moments where the parent did 1 of the 3 targets and shows to the parent in the next session. Video clips are shown of the parent in sessions 2 through 10.

Languages Materials are Available in

English, Spanish, German, Other*

*Contact purveyor about additional available languages.

Delivery Mode

Sessions are delivered in-person through home visits occurring with the child awake and at least one caregiver present. Sessions may be conducted virtually or in other community settings as needed and approved by model purveyor. 

Dosage

60-75 minutes session offered weekly for 10 consecutive weeks. Sessions occur while the child is awake and with the family in the home. 

Infrastructure for Implementation

Materials: Two separate devices when in person are needed- a video recorder and a device that can share video. May be able to do both these tasks on one device when providing ABC virtually. Must bring toys that lend towards creative play and not a "right or wrong" way to play (shakers and blocks versus puzzles) to sessions as well as supplies to make pudding (bowls, whisks, etc.) for one session in the infant model.

Space: Parent must have location where they are willing for a Parent Coach to come into or view through a phone or computer camera (typically occurs in the participating family’s home but may occur in other community settings based on family needs).

Staffing Requirements

There are no background or education requirements for Parent Coaches. Each community should create the implementation model that will be most effective and sustainable for their unique needs.

Parent Coaches must pass an interview specific to the model that assesses a potential trainee's ability to comment and their level of personal understanding on how early childhood impacts relationships. Parent Coaches who have a professional or personal understanding of early childhood often achieve fidelity markers sooner than individuals with other background experience. 

One full-time Parent Coach can serve 10-12 families at a time, or an estimated 40-48 families per year.

NCPC strongly recommends staff receive training in the Standards of Quality for Family Support and Strengthening. Contact Positive Childhood Alliance North Carolina (PCANC) or National Family Support Network (NFSN) for more information, training, and certification. 

Training for Model Fidelity

Parent Coaches must be trained to provide the model and complete weekly supervision sessions for the first year of implementation. In North Carolina, the Center for Child and Family Health (CCFH) provides training on the model’s main content as well as weekly supervision in-person for Parent Coaches. Supervisors at CCFH are endorsed by the ABC Infant model developer.

Contact Information

https://www.abcintervention.org/

https://www.ccfhnc.org/programs/training-services/

Mary Dozier, PhD: ABC Developer at University of Delaware; mdozier@udel.edu

Contact abcintervention@udel.edu for in-depth information about the model itself.

Dina Gerber, MS, LCSW: Clinical Faculty member at the Center for Child and Family Health; dina.gerber@duke.edu, 919-818-1177

Katharine Cannon, MEd: Ready Project Director and ABC Program Support at the Center for Child and Family Health; katharine.cannon@duke.edu

Kate Murray, PhD: Director of Post Adoption Support Services and ABC Parent Coach at the Center for Child and Family Health; kate.murray@duke.edu

Cost Estimates

Technology: $3,000/coach (for a laptop or computer if purchasing new) 

Mileage: Travel to 10 homes/week for 1 FTE (estimated $6,000/year for 1 FTE, or average $120/family for all in-person visits) 

Supplies: $25/family served 

Start-up costs for ABC Infant include Parent Coach training. Training is regularly available through the University of Delaware; their 2023 costs per parent coach trainee are $7000 for ABC Infant model training ABC services can begin immediately after Parent Coaches are trained in delivering the model. 

CCFH offers ABC Parent Coach training cohorts, which include implementation support, at no or low cost when grant funds are in place to support it. CCFH ABC training cohorts are expected to be offered in 2024-2025 and 2025-2026 through the ARCh Project. Visit the CCFH Training Services webpage for more information.

Purpose Service Code (PSC)

5525 – Home Visiting

Program Identifier (PID)

Attachment & Biobehavioral Catch-Up (ABC)

Minimal Outputs for NCPC Reporting

FY 24-25:

  • Number of parents/guardians participating

Minimal Outcomes for NCPC Reporting

FY 24-25:

  • Increase in positive parenting practices

Minimal Measures for NCPC Reporting

FY 24-25:

  • Parental Assessment of Protective Factors (PAPF)

NCPC Evidence Categorization

Evidence Based - 4 randomized controlled trials and 1 systematic review of randomized controlled trials. All studies utilized a comparison/control group. 3 of the studies were co-authored by the developer of ABC, Mary Dozier. 

Research Summary

Five of the most recent and relevant publications on ABC include a systematic review of randomized controlled trials (RCTs)1 and four RCTs.2 3 4 5 These studies sampled diverse families, including parents with educational attainment levels ranging from high school/GED to college degree or higher, families referred by child welfare services, internally adoptive parents, biological parents, foster parents, families experiencing high-risk housing (such as living in shelters or public housing developments), among other demographics. Most families identified as African American, Hispanic/Latin, biracial/multi-ethnic, or White and lived in the mid-Atlantic region of the United States. Child ages most commonly ranged from 6 months to 24 months, with a few studies sampling older children and/or conducting follow-up assessments through middle childhood. Results of these studies indicated that children receiving the ABC Infant intervention demonstrated fewer internalizing and externalizing behaviors than children in the control intervention group. Their parents reported fewer symptoms of depression and less intrusiveness than parents in the control group. Parents in the ABC Infant conditions demonstrated greater parental sensitivity and positive regard than parents in the control intervention group. Their children displayed higher rates of organized attachment and perceived attachment security than children in the intervention control group. The children in the ABC Infant group also demonstrated lower levels of anger, avoidance when distressed, anger toward parents, global anger, sadness, and negative affect expression than children in the control intervention group. Their cortisol regulation patterns were stronger than children in the intervention control group, and children in the ABC Infant group scored higher on the Peabody Picture Vocabulary Test when assessed at 2 years post-intervention, indicative of improved early language skill acquisition. 

  1. ^ See Grube & Limig (2018). This systematic review summarized findings from 10 randomized controlled trials (RCTs) evaluating the impacts of Attachment and Biobehavioral Catch-up (ABC). The studies reviewed included 10 RCTs, several of which utilized the same sample(s) and were considered follow-ups to the original, unique studies (3). The RCTs primarily utilized a pre/posttest design with the post-assessment typically occurring 1 month after completing ABC. All studies randomly assigned participants to the ABC intervention group, an intervention control group, or a treatment-as-usual control group. Eight of the 10 publications used the Developmental Education for Families (DEF) program as the model for the intervention control group. Most studies were located in the mid-Atlantic region of the United States with no clear indication of rural/urban settings. The studies' sample sizes ranged from 46 to 120 children living with either their biological parents or foster parents. All participants were involved in child welfare at the time of the study. Participants most frequently identified as African American, followed by White, with some participants identifying as biracial or Hispanic. Caregiver demographics varied, and some studies did not present any such information. Cortisol tests via saliva sampling were the most frequent measure used across the studies to demonstrate child-level outcomes. Several studies also used the Strange Situation Procedure, attachment diaries, the Tool Task, the Child Behavior Check List (CBCL), the Peabody Picture Vocabulary Test (3rd edition), and Dimensional Change Card Sort activity. Cortisol tests indicated that children in the ABC group had stronger cortisol regulation patterns than children in the DEF control group. Some studies found that children in the ABC group had higher waking levels of cortisol while others found higher waking levels of cortisol among children in the DEF group. The variance was attributed to differences in the sample populations. Additionally, studies found that children in the ABC group had lower levels of cortisol upon arriving to the Strange Situation lab than their peers in the DEF group. The ABC group's cortisol levels were not significantly different from that of children in the comparison group. The comparison group's cortisol levels were significantly lower than the cortisol levels of children in the DEF group. When assessed 3 years post-intervention, children in the ABC group continued to demonstrate higher levels of waking cortisol and a steeper, negative waking to bedtime cortisol-regulation pattern than children in the DEF group. Results of the Strange Situation Procedure indicated that children in the ABC group had significantly higher rates of organized attachment compared with children in the DEF group. Attachment diaries indicated that caregivers in the ABC group reported that their children showed less avoidance when distressed than caregivers in the control group. The Tool Task results found that children in the ABC group showed lower levels of anger, anger toward parent, global anger, sadness, and negative affect expression than children in the control intervention group. The ABC group also demonstrated fewer internalizing and externalizing behaviors than the control group, as measured by the CBCL. Children in the ABC group scored in the 45th percentile on the Peabody Picture Vocabulary Test when assessed at 2 years post-intervention, compared with the children in the DEF group who scored in the 28th percentile. Children in the ABC group received similar scores on the Dimensional Change Card Sort activity as their peers in a non-foster-care control group on measures of cognitive flexibility and theory of mind activities. Overall, these findings indicate that ABC regulates children's cortisol production and patterns, improves externalizing and internalizing problem behaviors, enhances attachment, and supports normative function development and early language skill acquisition. Study limitations include homogeneity in the location of studies, lack of control variables in most studies, limited demographic information, and the lack of variance in the intervention control groups (almost all studies used DEF). This systematic review is limited by its focus on child-level outcomes. As ABC is a parenting program, this overlooks any participant-level impacts. Additionally, 9 of the 10 studies reviewed were authored/coauthored by the developer of ABC (Dozier).
  2. ^ See Labella et al. (2018). This RCT was one in a series of RCTs designed to evaluate the impacts of ABC for children living in the mid-Atlantic region of the U.S. whose parents were referred by child protective services to participate in a foster care diversion program (n = 219), foster parents (n = 105), and internationally adoptive parents (n = 130). Parents were mostly female (95%), White (47%) or African American (42%), married (40%), and reported a median educational attainment of a high school diploma or equivalent. The median family income was $30,000-$39,000. Children were an average age of 17.7 months at the pre-intervention assessment and were assessed periodically through age 5 years. Measures included the Adult Attachment Interview (AAI) and video recordings of parent/child interactions assessed at pre- and post-intervention. Families were randomized to ABC (n = 240) or control intervention (n = 214) by project coordinator using randomly generated number sequence. Parents in the ABC group had significantly lower scores on the AAI dismissing dimension than parents in the control intervention group (p = 0.03). Both interventions included 10 60-min weekly sessions delivered in families' homes by trained providers. Most completed all 10 sessions (76%, M = 8.2). Observations of parent-child interactions occurred 1 month after the final intervention session and at annual follow-ups through age 5. Over half of parents' AAI results classified them as having an Autonomous state of mind (55%), followed by Dismissing (28%) and Preoccupied (10%). A small percentage did not meet classification criteria and were labeled Cannot Classify (7%) for the purpose of this study. At the first post-intervention assessment, children were an average age of 25.7 months. Results of the first post-intervention assessment indicated that parents in the ABC group demonstrated greater sensitivity (p < 0.01) and positive regard (p < 0.01) than the control intervention group. The ABC group also exhibited less intrusiveness (p = 0.03) than the control intervention group. There were no significant differences at first post-assessment on the effects of ABC for parents with different AAI classifications. At the final post-intervention assessment, children were, on average, 49.9 months. Parents in the ABC group showed significantly lower rates of intrusiveness (p < 0.01) at the final post-assessment. At this time, parents with a Dismissing classification on the AAI demonstrated less positive regard (p < 0.05) and those with a Preoccupied classification demonstrated greater intrusiveness (p < 0.01). Child age was associated with parental intrusiveness, such that parents with younger children showed more intrusiveness.
  3. ^ See Perrone et al. (2021). This randomized controlled trial evaluated the impacts of ABC for 200 parents and their 5–21-month-old infants (M = 11.82) from an urban community in New York City. About half (49%) of children were male and most identified as African American (61.5%), biracial/multi-ethnic (16%), or Hispanic/Latin (14%). Most primary caregivers were female (96%) and were the child's birth parent (91.5%). Families experienced high housing risk, with 35.9% of parents reporting living in a shelter and 25.5% living in public housing developments. Most parents reported an income level below the poverty threshold (83%). ABC coaches were trained to model fidelity and received regularly supervision. On average, it took families 14.39 weeks to complete all 10 ABC sessions. The average amount of time between baseline and follow-up visits was 7.19 months. Families were randomly assigned to receive the ABC intervention (n = 100) or to a waitlist control group (n = 100). Measures included a semistructured video-recorded play interaction coded on scales adapted from the Qualitative Scales of the Observational Record of the Caregiving Environment, the Center for Epidemiological Studies Depression Scale (CES-D), Adverse Childhood Experiences (ACEs) questionnaire, and demographic questionnaire used to assess risk. Over a third of parents scored at or above the CES-D clinical cutoff at baseline (36.9%) and follow-up (38.8%). Half of parents (51.3%) reported an ACE score of 4 or more out of 10. Cumulative risk scores ranged from 0.99 to 6.0, with the average score being 3.12. Over a third of parent-child dyads assigned to the ABC group did not complete all 10 sessions (37%). These parents had lower baseline scores for sensitivity (p = 0.047) and higher cumulative risk scores (p = 0.005). Results of the study indicated that parents in the ABC group displayed greater sensitivity at follow-up than the waitlist control group (p = 0.035). Parents who completed all 10 sessions reported more significant increases in sensitivity at follow-up (p = 0.007) as well as fewer reports of depression symptoms (p = 0.013) than the control group. There were no significant changes in measures of intrusiveness or positive regard for parents in the ABC group. Study limitations include the noncompletion rate for the ABC group (37%) and a lack of documentation of records to contact families after a cancellation or no show.
  4. ^ See Yarger et al. (2020). This randomized controlled trial evaluated the impacts of ABC for 120 internationally adopted children ages 6.8-48.4 months (M = 21.9) and their adoptive parents. About half of children were male (47.5%). The average age at adoption was 16.3 months and, on average, children started the intervention 6 months after adoption. At the first post-intervention visit, children were an average of 28.0 months. Most children were adopted from China (39.2%) and Russia (19.2%). Only primary caregivers were included, most of whom were female (94.2%), married (91.7%), White/non-Hispanic (95.0%), and highly educated (84.2% had a college education or higher). About a third of caregivers reported having at least one biological child living at home (32.5%). Parents were randomly assigned to the ABC intervention group or the control intervention group (Developmental Education for Families (DEF)) using a randomly generated number sequence. Both groups completed assessments pre- and post-intervention (about 4 weeks after the intervention) and annual follow-ups around the child's birthday until their 5th birthday. Measures included Demographics questionnaire and video-recorded play sessions coded with the Sensitivity, Intrusiveness, and Positive Regard scales adapted from the Observational Record of the Caregiving Environment. Most families completed three (22.5%) or four (34.2%) follow-up assessments. Children whose parents did not complete the intervention were significantly more likely to be male (p = 0.03). Results indicated that parents in the ABC group were more sensitive than their peers in the DEF control group at the first post-assessment (p < 0.01). This trend continued through 25-30 months post-intervention (p < 0.05). The ABC group also had a steeper rate of change in sensitivity than the DEF group, such that their scores increased by an average of 0.34 units from pre- to post-intervention, compared with the DEF group's scores decreasing by an average of 0.03 units. The ABC group's intrusiveness scores declined more steeply, with an average decrease from pre- to post-intervention of 0.15 units. The DEF group's scores on intrusiveness increased by an average of 0.41 points. The ABC group's intrusiveness scores became significantly lower than the DEF group's scores by the 12-month post-intervention follow-up (p < 0.01) and continued to be significantly lower through the 36-month post-intervention follow-up (p < 0.05). The ABC group's scores on positive regard significantly improved (p < 0.01) and increased by an average of 0.44 units from pre- to post-intervention, while the DEF group showed very little change (0.05 units). The significant difference in scores remained through the 24-month follow-up (p < 0.05). These results suggest that ABC improved adoptive parents' sensitivity and positive regard while decreasing intrusiveness and maintained significant for at least 1-year post-intervention. Study limitations include a sample population that was highly educated, predominantly married, and had a high income. The study also relied on the parenting quality of only one parent, who was typically female, which limits generalizability.
  5. ^ See Zajac et al. (2020). This study was a follow-up to a longitudinal study of the efficacy of ABC (Bernard et al., 2012, as cited in Zajac et al., 2020). This study focused on 212 families who were referred for the study by child welfare agencies in a large mid-Atlantic city as a foster care diversion program. For this study, only participants who completed an assessment in middle childhood were included in analyses (n = 100). About half of children were male (52%) and most identified as African American (66%). Most parents were female (97%), unemployed (80%), obtained less than a high school degree (60%), and had a household income of less than $10,000 (62%). Families were randomly assigned to the ABC intervention group (n = 100) or the Developmental Education for Families (DEF) control intervention group (n = 112). For this study, only participants who completed an assessment in middle childhood were included in analyses (ABC n = 44, DEF n = 56). Measures included the Kerns Security Scale completed in middle childhood (M age = 9.46 years). Results indicated that children in the ABC group had higher perceived attachment security ratings on the Kerns Security Scale (p = 0.023) compared with children in the DEF group. This finding persisted when controlling for government financial assistance (p = 0.023). Study limitations include a narrow scope, as only one outcome was assessed (attachment in middle childhood), and a lack of information regarding changes over time, which may include changes in the child's attachment security, parenting styles, parent-child separations, and other experiences not accounted for in this study.

Researched Population

  • Families with children living in the mid-Atlantic region of the United States
  • Children whose parents were referred by child protective services or child welfare services 
  • Internationally adoptive parents (children primarily adopted from China and Russia)
  • Foster parents
  • Families from diverse racial/ethnic backgrounds (including but not limited to White, African American, Hispanic/Latin, and biracial/multi-ethnic)
  • Families with varied levels of education attainment (ranging from high school/GED to college degree or higher)
  • Families from diverse socioeconomic backgrounds (below federal poverty level to 
  • Children ages 5-48 months, with some completing follow-ups through middle childhood 
  • Families in urban communities
  • Families experiencing high housing risk, such as living in a shelter or in public housing developments

Clearinghouse and Compendium References

Home Visiting Evidence of Effectiveness- rated “Meets Criteria” for General Population

California Evidence-Based Clearinghouse for Child Welfare- rated “Well Supported by Research Evidence”

Grube, W. A., & Liming, K. W. (2018). Attachment and Biobehavioral Catch-Up: A Systematic Review. Infant Mental Health Journal, 39(6). 656-673. https://doi.org/10.1002/imhj.21745 

Labella, M. H., Lee Raby, K., Bourne, S. V., Trahan, A. C., Katz, D., & Dozier, M. (2023). Is Attachment and Biobehavioral Catch-Up effective for parents with insecure attachment states of mind? Child Development, 95(2). 648-655. https://doi.org/10.1111/cdev.14002

Perrone, L., Imrisek, S. D., Dash, A., Rodriguez, M., Monticciolo, E., & Bernard, K. (2021). Changing parental depression and sensitivity: Randomized clinical trial of ABC's effectiveness in the community. Development and Psychopathology, 33. 1026-1040. https://doi.org/10.1017/S0954579420000310

Yarger, H. A., Bernard, K., Caron, E. B., Wallin, A., & Dozier, M. (2020). Enhancing Parenting Quality for Young Children Adopted Internationally: Results of a Randomized Controlled Trial. Journal of Clinical Child & Adolescent Psychology, 49(3). 378-390. https://doi.org/10.1080/15374416.2018.1547972

Zajac, L., Lee Raby, K., & Dozier, M. (2020). Sustained effects on attachment security in middle childhood: results from a randomized clinical trial of the Attachment and Biobehavioral Catch-up (ABC) intervention. The Journal of Child Psychology and Psychiatry, 61(4). 417-424. https://doi.org/10.1111/jcpp.13146 

All known research and publications are listed here: https://www.abcintervention.org/publications/. 



Local Partnerships Currently Implementing

Local Partnerships in purple have adopted Attachment & Biobehavioral Catch-Up (ABC) Infant. Local Partnership contact information can be found here.