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Zajac, L., Raby, K. L., & Dozier, M. (2019). Sustained effects on attachment security in middle childhood: Results from a randomized clinical trial of the Attachment and Biobehavioral Catch‐up (ABC) intervention. Journal of Child Psychology and Psychiatry, 61(4), 417–424. https://doi:10.1111/jcpp.13146

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; outcome not feasible to assess at baseline None None
Notes:

This manuscript analyzes findings from the same randomized controlled trial as Bernard et al. (2012), and additional contextual information about the study is from this source. Information to establish baseline equivalence of the groups on socioeconomic status was based on correspondence with the author.

Study characteristics
Study participants This randomized controlled trial (RCT) assigned parents to either ABC-Infant or a comparison home visiting program. Eligible families were those referred to Child Protective Services for risk of child maltreatment. At enrollment, children were younger than 2 years old. The follow-up was conducted when children were about 9 years old. The sample at follow-up included 100 children (44 in the ABC-Infant group and 56 in the comparison group). Characteristics of the ABC-Infant group (comparison group in parentheses) were as follows: 71 (68) percent of children were African American, 2 (13) percent were Caucasian, 21 (13) percent were biracial, 6 (6) percent were another race, and 21 (23) percent were Hispanic. Household income was less than $10,000 for 57 (66) percent of study families.
Setting The study was conducted in a large mid-Atlantic city.
Intervention services ABC-Infant, a brief parenting intervention consisting of 10 sessions each an hour long, occurred weekly in participants’ homes. Parent coaches conducted the sessions and provided parents with real-time feedback using videos of the sessions to highlight parenting strengths and weaknesses. The coaches also engaged parents in structured activities with their children and incorporated research findings in the information provided to the parents. The sessions focused on five topic areas: providing nurturance and interpreting child signals, responding in sensitive ways and delighting in the child, refraining from frightening behavior, identifying the parent’s personal challenges that may hinder nurturing parenting behavior, and consolidating the information and skills that parents learned.
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 promoting parental sensitivity or responsiveness 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 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.
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

Kerns Security Scale - Attachment security

FavorableUnfavorable or ambiguousNo Effect

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

Age 9

100 children Adjusted mean = 3.49 Adjusted mean = 3.28 Mean difference = 0.21 HomeVEE calculated = 0.48

Statistically significant, p= 0.02

Model controls for receipt of financial assistance from the government.

Moderate

Kerns Security Scale - Attachment security

FavorableUnfavorable or ambiguousNo Effect

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

Age 9

100 children Unadjusted mean = 3.49 Unadjusted mean = 3.28 Mean difference = 0.21 HomeVEE calculated = 0.46

Statistically significant, p= 0.02

Model does not include statistical controls.

Outcome measure summary

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

Kerns Security Scale - Attachment security

Attachment security was measured using the Kerns Security Scale, a 15-item, self-report questionnaire. Responses were averaged across the four-point scale for each item. Higher scores indicate higher levels of perceived attachment security to primary caregiver.

Child questionnaire administered by interviewer.

Internal consistency, a=.71