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