Mary Dozier University of Delaware
Increase risk to nearly every negative outcome imaginable
But probabilistic, not deterministic
▪ Increases risk, doesn’t cause bad outcomes
▪ We can intervene
But why so problematic?
Biologically prepared to depend on parents
Infants and young children
Temperature regulationNeuroendocrine regulationProtection from infectionProtection from danger Contact comfortSecurity
Consequences
Especially vulnerable are developing brain systems that are dependent on environmental input
▪ HPA axis▪ Amygdala ▪ Prefrontal cortex
Plasticity
H - HypothalamusP - PituitaryA – Adrenal
Cortisol an end product
Stress reactive function
▪ Body’s mounting a stress response
Diurnal function
▪ Organism functioning as diurnal (or nocturnal) creature
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
mg
/dl
Bernard et al., 2010, Archives Ped Adol Med
-1.3
-1.1
-0.9
-0.7
-0.5
Wake-up Bedtime
Lo
g-t
ran
sfo
rme
d C
ort
iso
l Va
lue
(in
ug
/dl)
Low-risk (n = 96)
Foster (n = 184)
Neglected (n = 155)
▪ HPA axis
▪ Amygdala
▪ Experience of adversity leads to sensitized amygdala
▪ Prefrontal cortex
Children who experienced adversity showed heightened amygdala activity in response to fear faces
(Tottenham, 2012)
Emotional Go-NoGo Task
▪ HPA axis
▪ Amygdala
▪ Prefrontal cortex▪ Decision making, planning, impulse control
▪ Control over amygdala
Adversity can affect the brain and behavior
But, interventions can reverse or change the trajectory
10- session intervention
Targets key issues identified as problematic for children who have experienced early adversity
Implemented in home
In the
Moment
Comments
Nurture
Follow
child’s lead
Avoid frightening
behavior
Behavioral
regulation
Biological
regulation
Enhanced
Parenting
ABC
Intervention
Targets of ABC Intervention
Nurturance especially important for children who have experienced early adversity
▪ Difficult to organize attachment behaviors without nurturing parent
This child needs you even though she may not appear to need you
Responding to child’s cues when child is not distressed
Critical to help child develop self-regulation
▪ Regulation of behavior, emotions, physiology
In the
Moment
Comments
Nurture
Follow
child’s lead
Avoid frightening
behavior
Behavioral
regulation
Biological
regulation
Enhanced
Parenting
ABC
Intervention
Targets of intervention
In the
Moment
Comments
Nurture
Follow
child’s lead
Avoid frightening
behavior
Attachment
quality
Early self-
regulation
Enhanced
Parenting
ABC
Intervention
Targets of intervention
Randomly assigned children and parents to Attachment and Biobehavioral Catch-up (ABC) or to an alternate intervention (DEF)
Focus here on outcomes for neglected/CPS-involved sample
Children birth-24 months at start of intervention
Control intervention focused on cognitive and motor development
Structure same as for ABC10 weekly sessions in home
Assessed in Strange Situation (Ainsworth et al., 1978) Parents CPS-involved N=120
Secure Insecure
Bernard, Dozier et al., Child Development, 2012
0%
20%
40%
60%
80%
100%
ABC Control
Pe
rce
nt
of
Ch
ild
ren
wit
h S
ecu
re v
s. In
secu
re
Att
ach
mn
en
t C
lass
ific
ati
on
s
Intervention GroupABC DEF
Secure
(52%)
Secure
(33%)
Insecure (48%) Insecure (67%)
Assessed at wake-up and bedtime post-intervention over 3 days
N=120
Bernard, Butzin-Dozier, Rittenhouse, & Dozier, 2010
-1.3
-1.1
-0.9
-0.7
-0.5
Wake-up Bedtime
Lo
g-t
ran
sfo
rme
d C
ort
iso
l Va
lue
(in
ug
/dl)
Low-risk (n = 96)
Foster (n = 184)
Neglected (n = 155)
-1.2
-1.1
-1
-0.9
-0.8
-0.7
-0.6
AM PM
Lo
g-t
ran
sfo
rmed
Co
rtis
ol (i
n u
g/d
l)
ABC
DEF
Bernard, Dozier, et al., 2015, Development and Psychopathology
-1.3
-1.2
-1.1
-1
-0.9
-0.8
-0.7
-0.6
AM PM
Lo
g-t
ran
sfo
rmed
Co
rtis
ol V
alu
e (u
g/d
L)
ABC
DEF
Bernard, Hostinar, & Dozier, 2015, JAMA - Peds
• Being able to sit quietly in school key to success
• Doing what one is supposed to do
• Inhibiting urge to do what one wants to do
Put attractive toys in front of child Tell him or her not to play with them, instead
play with crayons (boring in this context)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ABC DEF
34%Touched
53%Touched
Lind, et al., in press, Infant Mental Health Journal
Functional Magnetic Resonance Imaging (fMRI) Child views fearful and neutral faces
N=75 (25 ABC, 25 DEF, 25 low-risk)
Valadez, Tottenham, Dozier
Relative to DEF children , ABC children show greater activation of:
Medial Prefrontal Cortex Right insula
Valadez, Tottenham, Dozier
▪ Attachment
▪ DNA Methylation (whole genome analyses Hoye and Roth)
▪ Emotion expression (2 years post-intervention) (Lind)
▪ Language development (2 years post-intervention) (Freedman)
▪ Cortisol production (3 years post-intervention)
▪ Executive functioning (3 years post-intervention) ▪ Inhibitory control (Lind)
▪ Set-shifting (Lewis-Morrarty)
▪ Security (9-years-old) (Zajac)
▪ ANS regulation (9-years-old) (Tabachnick)
▪ Brain activation (9-years-old) (Valadez & Tottenham)
Parent:▪ Sensitivity (3 years post-intervention)▪ Neural activity/ERP (3 years post-intervention) (Bernard)▪ fMRI: Fusiform gyrus (Tottenham)▪ Attachment script knowledge (Raby)
Child:▪ Attachment▪ DNA Methylation (whole genome analyses Hoye and Roth)▪ Emotion expression (2 years post-intervention) (Lind)▪ Language development (2 years post-intervention) (Freedman)▪ Cortisol production (3 years post-intervention)▪ Executive functioning (3 years post-intervention)
▪ Inhibitory control (Lind)▪ Set-shifting (Lewis-Morrarty)
▪ Security (9-years-old) (Zajac)▪ ANS regulation (9-years-old) (Tabachnick)▪ Brain activation (9-years-old) (Valadez & Tottenham)
Substance Abuse and Mental Health Services Administration (SAMSHA) National Registry of Evidence-Based Practices (NREPP)https://www.samhsa.gov/nrepp
California Evidence-Based Clearinghouse for Child Welfare http://www.cebc4cw.org
Health Resources and Services Administration (HRSA) Maternal, Infant, and Early Childhood Home Visiting Programs (MIECHV)https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview
Delaware Hawaii Idaho Kansas Kentucky (n=1) Louisiana Maryland Michigan (n=2) Minnesota New York North Carolina Ohio (n=3) Oklahoma (n=4) Pennsylvania (n=3)
Mary DozierDepartment of Psychological and Brain Sciences
University of Delawarewww.abcintervention.org
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