Kristin Bernard

Enhancing Attachment Organization Among Maltreated Children: Results of a Randomized Clinical Trial

Young children who have experienced early adversity are at risk for developing disorganized attachments. The efficacy of Attachment and Biobehavioral Catch-up (ABC), an intervention targeting nurturing care among parents identified as being at risk for neglecting their young children, was evaluated through a randomized clinical trial. Attachment quality was assessed in the Strange Situation for 120 children between 11.7 and 31.9 months of age (M = 19.1, SD = 5.5). Children in the ABC intervention showed significantly lower rates of disorganized attachment (32%) and higher rates of secure attachment (52%) relative to the control intervention (57% and 33%, respectively). These results support the efficacy of the ABC intervention in enhancing attachment quality among parents at high risk for maltreatment.

Cortisol Production Patterns in Young Children Living With Birth Parents vs Children Placed in Foster Care Following Involvement of Child Protective Services

OBJECTIVE To examine differences in waking to bedtime cortisol production between children who remained with birth parents vs children placed in foster care following involvement of Child Protective Services (CPS). DESIGN Between-subject comparison of cortisol patterns among 2 groups of children. SETTING Children referred from the child welfare system. PARTICIPANTS Three hundred thirty-nine children aged 2.9 to 31.4 months who were living with birth parents (n = 155) or placed in foster care (n = 184) following CPS involvement as well as 96 unmatched children from low-risk environments. Main Exposures Involvement by CPS and foster care. Main Outcome Measure Salivary cortisol samples obtained at waking and bedtime for children on 2 days. RESULTS Child Protective Services-involved children who continued to live with birth parents and CPS-involved children placed in foster care differed in cortisol production, with children living with their birth parents showing flatter slopes in waking to bedtime values. CONCLUSIONS Continuing to live with birth parents following involvement of CPS is associated with greater perturbation to the diurnal pattern of cortisol production than living with foster parents. Foster care may have a regulating influence on childrens cortisol among children who have experienced maltreatment.

Examining Infants' Cortisol Responses to Laboratory Tasks among Children Varying in Attachment Disorganization: Stress Reactivity or Return to Baseline?.

Cortisol is a hormone involved in mounting a stress response in humans. The evidence of stress reactivity among young children has been mixed, however. In the present study, the order of two laboratory tasks (i.e., Strange Situation and play) was counterbalanced, and home saliva samples were obtained. Saliva samples were also collected upon the childrens arrival at the laboratory and at 40, 65, and 80 min after arrival. The authors examined changes in cortisol using piecewise hierarchical linear modeling, testing whether observed increases reflected a return to baseline or stress reactivity. An interaction between attachment disorganization and task emerged, such that disorganized infants showed increases in cortisol in response to the stressor compared with play, whereas organized infants did not show cortisol reactivity to either task. Implications for the buffering effects of maternal care on stress reactivity are discussed.

Cognitive Flexibility and Theory of Mind Outcomes Among Foster Children: Preschool Follow-Up Results of a Randomized Clinical Trial

Young children who experience early adversity are at risk for problems regulating emotions, behavior, and physiology, which in turn place them at risk for later psychopathology, school problems, and peer relation difficulties. Therefore, early parenting interventions are critical in helping this vulnerable population develop adequate self-regulatory capabilities. Attachment and Biobehavioral Catch-up (ABC) is an intervention developed to help parents learn to behave in ways that enhance young childrens self-regulatory capabilities. In the present study, we found that preschool-aged foster children who had received the ABC intervention showed stronger cognitive flexibility and theory of mind skills, relative to foster children who had received a control intervention. Foster children who had received the ABC intervention showed capabilities in these areas that were not significantly different from a comparison group of children who were never in foster care. These findings are promising in suggesting that the ABC intervention enhances the development of foster childrens self-regulatory capabilities.

Intervening to enhance cortisol regulation among children at risk for neglect: Results of a randomized clinical trial

The hypothalamus-pituitary-adrenal axis is particularly sensitive to conditions of maltreatment. In particular, neglected children have shown a flatter slope with lower wake-up values relative to nonneglected children. An intervention, the Attachment and Biobehavioral Catch-Up (ABC), was developed to enhance biological and behavioral regulation in young children at risk for neglect. The effectiveness of the intervention was assessed in a randomized clinical trial for children with involvement with Child Protective Services. Following the intervention, children receiving the ABC intervention (n = 49) showed more typical cortisol production, with higher wake-up cortisol values and a steeper diurnal slope, than children receiving the control intervention (n = 51). These results suggest that the ABC intervention is effective in enhancing biological regulation.

Maternal Sensitivity: Within-Person Variability and the Utility of Multiple Assessments

In this study, we examined within-person variability in maternal sensitivity among a culturally diverse sample of high-risk mother-infant dyads (N = 25). We also examined incremental increases in effect sizes between maternal sensitivity and two related variables, attachment state of mind and child removal from the home, as a function of increasing observations of maternal sensitivity. The dyads were videotaped during 10 1-hour-long home visits and maternal sensitivity was coded using the abbreviated (25-item) version of the Maternal Behavior Q-Sort (MBQS). Attachment state of mind was assessed using the Adult Attachment Interview (AAI). Within-person variability in maternal sensitivity was greater for nonautonomous mothers compared to autonomous mothers. Mothers who were relatively low in maternal sensitivity were more likely to be nonautonomous and also more likely to have their child removed from their home by child protective services. Results from data sampling trials showed incremental increases in these effect sizes as the number of observations of maternal sensitivity increased. Fewer observations of maternal sensitivity resulted in systematic underestimates of effect sizes between maternal sensitivity and related variables. We discuss the implications for maltreatment researchers and interventionists.

Parental synchrony and nurturance as targets in an attachment based intervention: building upon Mary Ainsworth’s insights about mother–infant interaction

As an astute observer of parent–infant interaction, Mary Ainsworth described and assessed facets of maternal sensitivity, including responsiveness to conditions of infant distress and non-distress. This paper considers the importance of distinguishing between parental sensitivity to children’s distress cues (which we refer to as nurturance) and parental sensitivity to children’s non-distress cues (which we refer to as synchrony). Observations of parents in our intervention, Attachment and Biobehavioral Catch-up (ABC), have led us to believe that distress and non-distress represent distinct contexts in which parents can be differentially sensitive or insensitive in responding. Thus, we have conceptualized nurturance and synchrony as distinct targets of the ABC intervention and, in deciding how to assess parental sensitivity, we have chosen measures that distinguish between nurturance and synchrony. This paper describes the strengths and weaknesses of different approaches we have taken to assess parental sensitivity, including diary methodology that we developed for assessing parental nurturance and global measures that we have used for assessing parental synchrony. Finally, a frequency-based coding system is described that we developed for assessing parental nurturance and synchrony from videotaped intervention sessions.

Intervention effects on negative affect of CPS-referred children: Results of a randomized clinical trial

Exposure to early adversity places young children at risk for behavioral, physiological, and emotional dysregulation, predisposing them to a range of long-term problematic outcomes. Attachment and Biobehavioral Catch-up (ABC) is a 10-session intervention designed to enhance childrens self-regulatory capabilities by helping parents to behave in nurturing, synchronous, and non-frightening ways. The effectiveness of the intervention was assessed in a randomized clinical trial, with parents who had been referred to Child Protective Services (CPS) for allegations of maltreatment. Parent-child dyads received either the ABC intervention or a control intervention. Following the intervention, children from the ABC intervention (n=56) expressed lower levels of negative affect during a challenging task compared to children from the control intervention (n=61).

Effects of early adversity on young children's diurnal cortisol rhythms and externalizing behavior

Early adversity is associated with biological and behavioral dysregulation in early childhood. We examined whether early adversity (i.e., poverty and involvement with child protective services [CPS]) had an indirect effect on externalizing behavior through HPA axis dysregulation, specifically blunted diurnal cortisol patterns. Participants included 94 children between the ages of 3.94 and 6.52 years old, who had a history of CPS involvement (n = 53) or no history of CPS involvement (n = 41). Cortisol samples were collected at wake-up and bedtime across 3 days, and parent-reported externalizing behavior was assessed using the Child Behavior Checklist. Results showed that history of CPS involvement and poverty were associated with blunted cortisol patterns, which in turn led to elevated externalizing behavior. The indirect effect of CPS involvement on externalizing behavior through blunted cortisol was significant, whereas the indirect effect of poverty on externalizing behavior was nonsignificant. Findings add to our understanding of neurobiological mechanisms linking early adversity to psychopathology.

Examining Change in Cortisol Patterns During the 10‐Week Transition to a New Child‐Care Setting

The transition to out-of-home child care brings a number of challenges for children, including complex peer interactions and extended separations from parents. Children often show a midmorning to afternoon rise in cortisol on child-care days, compared to the typical diurnal decline seen at home. Changes in cortisol were examined in a wide age range of children (N = 168; 1.2 months to 8 years, M = 3.27 years) during the 10-week transition to a new child-care setting. Structural equation modeling using latent change scores showed that children experienced an increase in the cortisol rise at child care across the 10-week transition. Furthermore, child age moderated the difference between home- and child-care cortisol patterns. Findings are placed in a developmental context, and potential implications and future directions are discussed.