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Yarger, H. A., Bronfman, E., Carlson, E., & Dozier, M. (2019). Intervening with Attachment and Biobehavioral Catch-up to decrease disrupted parenting behavior and attachment disorganization: The role of parental withdrawal. Development and Psychopathology. Advance online publication. https://doi.org/10.1017/S0954579419000786

Model(s) Reviewed: Attachment and Biobehavioral Catch-Up (ABC) -Infant
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
Moderate Randomized controlled trial High Established on race/ethnicity and SES; outcomes not feasible to assess at baseline None None
Notes:

This manuscript analyzes findings from the same randomized controlled trial as Bernard et al. (2012). Additional contextual information about the study and to determine attrition is from Bernard et al. (2012) and based on correspondence with the author.

Study characteristics
Study participants This randomized controlled trial (RCT) assigned eligible families to either ABC-Infant or a comparison home visiting program. Eligible families were participants in a foster care diversion program with children younger than 2 years who were referred to the program from Child Protective Services for various issues placing children at risk (for example, domestic violence, parental substance use, homelessness, or neglect). A total of 105 mother-child dyads were included in the study at follow-up (50 in the ABC-Infant group and 55 in the comparison group). In the ABC-Infant group, 64 percent of children were African American, 12 percent were Caucasian, 24 percent were biracial, and 20 percent were Latino. The majority (56 percent) of households reported an annual income of less than $10,000.
Setting The study was conducted in a large mid-Atlantic city.
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 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, the components related to parental sensitivity were removed to distinguish it from ABC-Infant.
Staff characteristics and training The staff in both groups were selected based on their experience in working with children and their interpersonal skills. Parent coaches received training and supervision as appropriate to their roles.
Funding sources This research was supported by Award Numbers R01MH052135, R01MH074374, and R01MH084135 from the National Institute of Mental Health.
Author affiliation Mary Dozier, one of the authors of the study, is a developer of the ABC home visiting program model. Elisa Bronfman, another author, is a developer of the current Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) manual.
Study Registration:

Clinicaltrials.gov Identifier: NCT02093052. Study registration was assessed by HomVEE beginning with the 2014 review.

Findings details

Child development and school readiness
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 - Disorganized attachment

FavorableUnfavorable or ambiguousNo Effect

ABC-Infant vs. DEF; Large mid-Atlantic city

7 months after enrollment (1 month post-intervention)

105 children Unadjusted proportion = 0.32 Unadjusted proportion = 0.46 Mean difference = -0.14 HomeVEE calculated = -0.34

Not statistically significant, p= 0.16

Positive parenting practices
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Disrupted parenting

FavorableUnfavorable or ambiguousNo Effect

ABC-Infant vs. DEF; Large mid-Atlantic city

7 months after enrollment (1 month post-intervention)

105 mothers Unadjusted proportion = 0.52 Unadjusted proportion = 0.62 Mean difference = -0.10 HomeVEE calculated = -0.24

Not statistically significant, p= 0.31

Moderate

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Parental affective communication errors

FavorableUnfavorable or ambiguousNo Effect

ABC-Infant vs. DEF; Large mid-Atlantic city

7 months after enrollment (1 month post-intervention)

105 mothers Not reported Not reported Not Reported HomeVEE calculated = 0.31

Not statistically significant, p = 0.33

Moderate

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Parental fearful/disoriented

FavorableUnfavorable or ambiguousNo Effect

ABC-Infant vs. DEF; Large mid-Atlantic city

7 months after enrollment (1 month post-intervention)

105 mothers Not reported Not reported Not Reported HomeVEE calculated = 0.12

Not statistically significant, p= 0.52

Moderate

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Parental intrusive/negativity

FavorableUnfavorable or ambiguousNo Effect

ABC-Infant vs. DEF; Large mid-Atlantic city

7 months after enrollment (1 month post-intervention)

105 mothers Not reported Not reported Not Reported HomeVEE calculated = 0.10

Not statistically significant, p= 0.60

Moderate

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Parental role/boundary confusion

FavorableUnfavorable or ambiguousNo Effect

ABC-Infant vs. DEF; Large mid-Atlantic city

7 months after enrollment (1 month post-intervention)

105 mothers Not reported Not reported Not Reported HomeVEE calculated = -0.32

Not statistically significant, p= 0.74

Moderate

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Parental withdrawal

FavorableUnfavorable or ambiguousNo Effect

ABC-Infant vs. DEF; Large mid-Atlantic city

7 months after enrollment (1 month post-intervention)

105 mothers Unadjusted mean = 3.76 Unadjusted mean = 4.42 Mean difference = -0.66 Study reported = -0.42

Statistically significant, p= 0.03

Outcome measure summary

Child development and school readiness
Outcome measure Description of measure Data collection method Properties of measure

Strange Situation Procedure - Disorganized attachment

The Strange Situation is a laboratory assessment of children's reliance on the parent when they are distressed.

Parent-child assessment

Interrater reliability=.89

Positive parenting practices
Outcome measure Description of measure Data collection method Properties of measure

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Disrupted parenting

A categorical indication of whether the parent is disrupted or not using the AMBIANCE coding system.

Parent-child assessment

Interrater reliability=.90

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Parental affective communication errors

AMBIANCE is a coding system that assesses negative parenting practices on a 7-point scale. Parental affective communication errors is exemplified by parents' failure to respond appropriately to children's cues.

Parent-child assessment

Interrater reliability=.80

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Parental fearful/disoriented

AMBIANCE is a coding system that assesses negative parenting practices on a 7-point scale. Parental fearful/disoriented behavior is characterized by parents appearing to be disoriented or afraid of child.

Parent-child assessment

Interrater reliability=.68

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Parental intrusive/negativity

AMBIANCE is a coding system that assesses negative parenting practices on a 7-point scale. Parental intrusiveness/negativity is characterized by a parents' physical and/or verbal abuse of their children.

Parent-child assessment

Interrater reliability=.85

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Parental role/boundary confusion

AMBIANCE is a coding system that assesses negative parenting practices on a 7-point scale. Parental role/boundary confusion is characterized by parents placing their needs over those of their children.

Parent-child assessment

Interrater reliability=.73

Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale - Parental withdrawal

AMBIANCE is a coding system that assesses negative parenting practices on a 7-point scale. Parental withdrawal is exemplified by parents distancing themselves from their children via physical or verbal cues.

Parent-child assessment

Interrater reliability=.74