mary dozier infant-caregiver lab university of delaware many paths to enhancing parent child...
TRANSCRIPT
Intervening with Foster and High-Risk Families:
Attachment and Biobehavioral Catch-up
Mary DozierInfant-Caregiver LabUniversity of Delaware
Many Paths to Enhancing Parent Child Relationships
Orlando, FloridaApril 23, 2014
Infant reliance on parent
Temperature regulationNeuroendocrine regulationProtection from infectionProtection from danger Contact comfortSecurity
Please note that not all slides are included here. This will, though, provide a general outline to follow along if you would like.
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
Attachment and Biobehavioral Catch-up
10- session intervention
Targets key issues identified as problematic for children who have experienced early adversity
Implemented in home
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)
Issue Intervention target
Children push caregiver away
Children need nurturance even though they fail to elicit it
Children dysregulated behaviorally and biologically
Children need responsive care to help them develop regulatory capabilities
Parents behave in frightening ways
Children need parents who are not frightening
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.
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
Intervention strategies
Help parents to change through:Issues raised through manualVideo feedbackIn The Moment feedback
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
HPA system
H - HypothalamusP - PituitaryA – Adrenal
Cortisol an end product
Sensitive to effects of early experience
HPA system: 2 orthogonal functions
Stress reactive function Body’s mounting a stress response
Diurnal function Organism functioning as diurnal (or
nocturnal) creatureWe (and many others) have found more action
with diurnal function
When we measure cortisol
Wak
e-up
30-m
in
mid
-am
mid
-aft
bedtim
e0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
mg/
dl
Early Adversity and Diurnal Cortisol
Bernard, Butzin-Dozier, Rittenhouse, & Dozier, 2010
Wake-up Bedtime
-1.2
-1
-0.8
-0.6
-0.4Low-risk (n = 96)
Foster (n = 184)
Neglected (n = 155)
Log
-tra
nsf
orm
ed
Cort
isol V
alu
e
(in
ug
/dl)
Dysregulation
Biological dysregulation: cortisol Behavioral dysregulation:
Behavior problems Inhibitory control
Second target for intervention: Helping children develop better regulatory capacities
Synchronous interactions predict better regulatory capabilities (Raver, 1996)
Frightening behavior
Many parents behave in frightening ways• way to control behavior • response to distress • unaware (even dissociating)
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
Problem Target Outcome
Children push caregiver away
Provide nurturance even though children fail to elicit it
Secure, organized attachment
Children dysregulated behaviorally and biologically
Provide responsive care
Enhanced regulatory capabilities
Parents behave in frightening ways
Don’t behave in frightening ways
Assessing effectiveness
Randomly assigned children and parents to ABC or to an alternate intervention (DEF)
120 children, half in ABC, half in DEF
Intervention Effects on Diurnal Cortisol Production
Wake-up Bedtime-1.2
-1.1
-1
-0.9
-0.8
-0.7
-0.6
ABC PostDEF PostABC Follow-upDEF Follow-up
Sample
Lo
g-t
ran
sfo
rme
d C
ort
iso
l (i
n u
g/d
l)
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
Percentage Disorganized Attachment Among Children in ABC and DEF Interventions
Bernard, Dozier et al., Child Development, 2012
Foster Toddlers
Preliminary data from Preschool Strange Situation
Intervention includes calming in addition to nurturance, synchrony, non-frightening behaviors
Percentage Secure Attachment Among Foster Children in ABC and DEF Interventions (Toddlers/Preschool SS)
ABC DEF0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Secure(84%)
Secure(44%)
Insecure(16%)
Insecure (56%)
Intervention Group
Perc
ent
of
Childre
n w
ith S
ecure
vs.
Insecure
A
ttachm
ent
Cla
ssifi
cati
ons
Assessment of emotion expression
Assess emotion expression/regulation in challenging task (Tool Task)
N=120
Negative Affect Among Children in ABC and DEF Interventions
Anger Anger towards CG
Negative Affect0
1
2
3
4
ABC
DEF
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
Pre-switch Post-switch0
1
2
3
4
5
6
7Non-fosterFoster controlFoster ABC
Ta
sk
Pe
rfo
rma
nc
e
(Nu
mb
er
Co
rre
ct)
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
Attachment and Biobehavioral Catch-up
10 session intervention In home In the moment comments
Most critical aspect
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….
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
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
ABC
Evidenced based intervention Effects on attachment, physiology, etc. Uses in the moment commenting as
central
Example of pre-intervention to montage
Acknowledgments
NIMH R01 52135, 84135, 74374 Philadelphia DHS Delaware DFS Edna Bennett Pierce
Infant-Caregiver Lab