Bernard, K., Frost, A., Jelinek, C., & Dozier, M. (2019). Secure attachment predicts lower body mass index in young children with histories of child protective services involvement. Pediatric Obesity, 14(7), e12510. https://doi.org/10.1111/ijpo.12510
Manuscript Detail
Model(s) Reviewed: Attachment and Biobehavioral Catch-Up (ABC) -Infant
| Screening decision | Screening conclusion |
|---|---|
| Passes screens | Eligible for review |
| Rating | Design | Attrition | Baseline equivalence | Reassignment | Confounding factors |
|---|---|---|---|---|---|
| Moderate | Randomized controlled trial | High | Established on race/ethnicity and SES; outcome not feasible to assess at baseline | None | None |
Notes:
The study authors used a linear growth mediation model to examine the effect of ABC-Infant on changes in body mass index (BMI) from ages 2 to 4 as mediated through secure attachment, as well as the direct effect on secure attachment itself. The indirect effects on BMI are ineligible for review by HomVEE. Information on baseline equivalence was based on correspondence with the author.
| Study participants | Participants were recruited through referrals by Child Protective Service agencies. After receiving parental consent, children were randomized to either ABC-Infant or the comparison condition, which also provided home visits. Sixty-three percent of children in the analytic sample identified as African American, 20 percent as biracial or multiracial, 9 percent as Hispanic, and 8 percent as Caucasian. Among parents reporting income data, 93 percent reported incomes below the poverty level. The average maternal age at the child’s birth was 28, and children were younger than 24 months at the time of referral. |
|---|---|
| Setting | Newark, Delaware |
| Intervention services | ABC-Infant consisted of 10 weekly hour-long home visits. The sessions focused on five topic areas: providing nurturance, following the child’s lead, refraining from frightening behavior, parents recognizing the effect of their own childhood experiences on their parenting behavior, and learning the importance of touch and children’s emotions. Across all sessions, parent trainers engaged parents in structured activities with their children and then provided feedback on observations of participants’ parenting behavior, both in real-time and by playing back video recordings from the sessions. |
| Comparison conditions | Comparison families received Developmental Education for Families (DEF) in home visits that were of the same duration (10 hour-long sessions) and frequency (weekly) as ABC-Infant. DEF was designed to enhance cognitive and linguistic development. For this study, components related to parental sensitivity were excluded. |
| Staff characteristics and training | Trained parent coaches conducted home visits and participated in weekly group supervision, including video review by a trained supervisor. |
| Funding sources | This research was supported in part by Award Numbers R01MH052135, R01MH074374, and R01MH084135 from the National Institute of Mental Health. |
| Author affiliation | Mary Dozier is a developer of the ABC home visiting program model. |
Study Registration:
Clinicaltrials.gov Identifier: NCT02093052. Study registration was assessed by HomVEE beginning with the 2014 review.
Findings details
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Strange Situation Procedure - Secure attachment |
FavorableUnfavorable or ambiguousNo Effect |
ABC-Infant vs. DEF; Delaware |
First post-intervention visit where child was at least 1-year old (range 11.8 to 31.9 months old) |
105 children | Adjusted proportion = 0.52 | Adjusted proportion = 0.32 | Mean difference = 0.20 | HomeVEE calculated = 0.43 | Statistically significant, p= 0.03 |
Model controls for child gender and cumulative social risk index. |
Outcome measure summary
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Strange Situation Procedure - Secure attachment |
The Strange Situation Procedure is a laboratory assessment of children's reliance on a parent when they are distressed. |
Parent-child assessment |
Not reported |