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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

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:

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 characteristics
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

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 - 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

Child development and school readiness
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