Cognitive flexibility and theory of mind outcomes among foster children: preschool follow-up results of a randomized clinical trial

Building resilience in families experiencing homelessness through integration of health, parenting and child development programs

Children who experience homelessness are vulnerable to mental health problems, developmental delays and lower academic achievement. Research suggests that parental health literacy, sensitive parenting behaviour and child self-regulation are modifiable mechanisms that might enhance children's resilience to adversities associated with homelessness, yet empirical evidence on implementing such interventions in shelter settings is limited. Through a coordinated academic-community partnership, this study aimed to examine the (1) feasibility of conducting an integrated health approach in shelter settings and (2) the effectiveness of separate interventions on child and parent outcomes. Results are discussed in terms of best practices in shelter settings and building resilience in families experiencing homelessness with young children.

A follow up investigation of placental pathology, responsive parenting, and preschool children's executive functioning and language development

Despite documented effects linking underlying placental diseases and neurological impairments in children, little is known about the long-term effects of placental pathology on children's neurocognitive outcomes. In addition, maternal responsivity, known to positively influence early postnatal cognitive development, may act to protect children from putative adverse effects of placental pathology. The current study is a follow up of medically healthy, term born, preschool age children, born with placental pathology. A sample of 118 children (45 comparison children with normal placental findings, 73 born with placental pathology) were followed when children were 3-4 years old. In comparison to children born to mothers with normal placentas, placental pathology was associated with poorer performance in the executive function involving cognitive flexibility, but not inhibitory control or receptive language. Maternal responsivity was observed to be marginally protective on the impact of placental pathology risk on cognitive flexibility, but this was not seen for either inhibitory control or receptive language.

Systematic Review of the Evaluation of Foster Care Programs

OBJETIVE

The aim of this study was to conduct an exhaustive synthesis to determine which instruments and variables are most appropriate to evaluate foster care programs (foster, kinship, and professional families). This evaluation includes the children, their foster families, their families of origin, professionals, and foster care technicians.

METHOD

The systematic review included randomized, quasi-randomized, longitudinal, and control group studies aimed at evaluating foster care interventions.

RESULTS

A total of 86 studies, 138 assessment instruments, 18 constructs, and 73 independent research teams were identified.

CONCLUSIONS

(1) although the object of the evaluations was the children, the informants were usually the people in charge of their care; therefore, effort should be made to involve the children in a more participatory way; (2) psychosocial functioning, behavior, and parenting are transversal elements in most evaluations, while quality of life and coping are not sufficiently well incorporated; (3) practical instruments (brief and easy to apply and correct) that are widely used and carry scientific guarantees should be prioritized to ensure the comparability and reliability of the conclusions; and (4) progress should be made in the study of evaluation models for all forms of foster care, including foster, extended, and specialized families.

Enhancing early parenting in the community: Preliminary results from a learning collaborative approach to scale up Attachment and Biobehavioral Catch-up

Attachment and Biobehavioral Catch-up (ABC) is a promising home-visiting intervention promoting sensitive caregiving and secure parent-child attachment in families with young children. The goal of this study was to examine a learning collaborative approach to disseminating ABC in a community setting. Training outcomes (e.g., trainee completion, satisfaction, effectiveness of training methods) and intervention outcomes (e.g., parent behavior, parent beliefs, child socioemotional development) were examined. Eighteen practitioners participated in the ABC learning collaborative; 13 completed training. Quantitative and qualitative measures indicated that trainees were satisfied with their experience and valued the unique collaboration opportunities offered by the learning collaborative. In addition, trainees served 67 families in the community, 37 of whom completed all sessions of ABC. The study was conducted in the United States. Racial demographics of the children in the sample included: 56.7% White, 22.4% Black/African-American, 17.9% Bi- or Multi-racial, and 3.0% unknown. Regarding ethnicity, 80.6% were Non-Hispanic/Latino, 10.4% were Hispanic/Latino, and 9.0% were unknown. Caregivers who completed ABC showed more sensitive parenting behavior and reported positive changes in their perceived self-efficacy and their beliefs around infant crying. Children who received ABC showed increased socioemotional functioning. Results demonstrate successful dissemination of ABC in the community using a learning collaborative approach.

The effect of relationship-based interventions for maltreated children and adolescents: a systematic review and meta-analysis

Child maltreatment is characterized by a harmful relational environment which can have negative cascading consequences for the child's development. Relationship-based interventions may improve maltreated children's functioning by addressing key aspects of the parent-child relationship at various stages of development. The objective of the current study was to perform a systematic review on relationship-based interventions for maltreated children and a meta-analysis on the impact of these interventions on observed parent-child relational behavior. Data collection consisted of a comprehensive literature search in six databases and contacting experts in the field and hand searching relevant publications. In total, 5,802 abstracts were screened, of which 81 relevant publications were identified, representing 4,526 participants. The meta-analysis found large improvements in observed parent interactive behavior (g = 0.888), smaller improvements in child attachment (g = 0.403) and child interactive behavior (g = 0.274). The effect on parent interactive behavior was larger in interventions addressing middle childhood. Risk of bias assessments showed that a large number of studies suffer from poor reporting, which limits the conclusions of the findings. Future research should examine parent-child relationship behavior across multiple developmental stages, as well as the impact of developmentally appropriate intervention elements on maltreated children.

A qualitative exploration of caregivers' experiences with the Attachment and Biobehavioral Catch-up (ABC) parenting program

In the face of childhood adversity, services and interventions can improve a child's life trajectory by promoting healthy development, enhancing protective factors, and building resilience through stable and supportive relationships. One such service, a specific and highly researched home visiting intervention, Attachment and Biobehavioral Catch-up (ABC), is often provided to families through home visiting service programs. This qualitative descriptive study examines the experiences of caregivers (N = 18) who received ABC as part of a statewide early childhood initiative in one midwestern state. Participants provided insight into the context of their lives before and during the intervention. They described their perspectives of the utility of the program and its influence on their family's behaviors and interactions. Findings demonstrate that coaching support bolstered caregivers' confidence in effective strategies and guided them through caregiving challenges. Caregivers observed growth in their caregiving practices, their infants' and young children's social and emotional skills, and their dyadic caregiver-child relationships, demonstrating the benefits of participating in and completing the ABC intervention.

Association of cognitive flexibility with neural activation during the theory of mind processing

Theory of mind (ToM), which is the ability to infer and reason about others' mental states, plays a key role in successful social interactions. Previous studies have shown that cognitive flexibility (CF), which refers to the ability to adequately switch between different perspectives, is linked to ToM performance in a variety of experimental tasks. However, the mechanisms of the association between CF and ToM is still largely unknown. Here, we investigated the relation of CF with neural activity during ToM processing in 26 healthy male adults using a functional magnetic resonance imaging task of moving shapes in social patterns. The CF abilities were estimated using the self-report Cognitive Flexibility Scale. Diverse brain areas, including the middle frontal gyrus (MFG), inferior frontal gyrus, amygdala, precuneus, and temporoparietal junction (TPJ), were activated during ToM processing. In these areas, individual differences in CF abilities were associated with the strength of neural activity in the right MFG and TPJ. These findings highlight the notion that cognitive ability to switch between different perspectives according to a changing environment is crucial for the attribution of mental state to others, and suggest that the right MFG and TPJ are deserving of further examination for the development of new therapies to improve social cognition in clinical populations.

Childhood Maltreatment and Creativity among Chinese College Students: A Serial Mediation Model

Creativity plays a very crucial impact on our cultural life and has also been important to the improvement of human civilization. Numerous studies have indicated that family circumstance plays an important role in the development of individual creativity. However, little is known about the mediating mechanisms underlying the association between childhood maltreatment and creativity. This study intended to explore the serial multiple mediation model in which undergraduates' cognitive flexibility and self-efficacy were proposed to mediate the potential influence of childhood maltreatment on their creativity. Participants were 1069 undergraduates (573 males and 496 females, mean age was 20.57 ± 1.24 years ranging from 17 to 24) from a university in Shandong Province, China. Participants were required to complete an internet survey including the Short Form of Childhood Trauma Questionnaire (CTQ-SF), General Self-Efficacy Scale (GSES), Cognitive Flexibility Inventory (CFI), and Williams Creativity Aptitude Test (WCAT). Serial multiple mediation analysis and the bootstrap method were used to investigate the mediation effects of cognitive flexibility and self-efficacy. The results showed that childhood maltreatment indirectly influenced undergraduates' creativity through three indirect paths: childhood maltreatment→cognitive flexibility→creativity, childhood maltreatment→self-efficacy→creativity, and childhood maltreatment→cognitive flexibility→self-efficacy→creativity. The ratios of the total indirect effects and branch-indirect effects to the total effects were 92.73%, 34.61%, 35.68%, and 22.44%, respectively. These results indicated that cognitive flexibility and self-efficacy could completely mediate the potential impact of childhood maltreatment on individuals creativity.

The impact of the "Attachment and Biobehavioural Catch-Up" program on attachment related parent behavior-A systematic review

"Attachment and Biobehavioural Catch-Up" (ABC) is a 10 session home visiting program, grounded in attachment theory. It aims to improve child emotion regulation, attachment and behavioral outcomes through changing caregivers' attachment related behaviors. There is increasing evidence with respect to the effectiveness of ABC in producing positive child outcomes, but the intervention's direct effect on parent outcomes remains unclear. This review examined the association of ABC with attachment related parent outcomes. The PubMed, EMBASE, PyschINFO and SCOPUS databases were searched for relevant studies in August 2021, and again in April 2022. The eligibility criteria for included studies were (1) infants aged 0-27 months at time of the ABC intervention, (2) "at risk" parents, (3) controlled trials published in peer-reviewed journals and (4) utilized a measure of attachment related parent outcomes. Eleven eligible studies were included. The findings showed ABC had a significant small to medium effect on a variety of attachment related parent outcomes among parents presenting with multiple psychosocial risk factors. "Sensitivity" was measured most frequently, with small to medium main effect sizes recorded at follow-up, compared to controls. Implications for the clinical effectiveness of the ABC program in community settings are discussed. Future research should clarify who ABC is most effective for and how it compares to similar interventions.

Regression in Early Childhood Development: An Unintended Outcome of Prolonged Hospitalization?

This brief review outlines a novel case study with targeted literature search. Patient X was a 21-month-old male who was receiving ongoing treatment for stage M MYCN-amplified high-risk neuroblastoma. Patient X's mother was considering refusal of further cancer-directed therapy because of the child's developmental regression noted during his prolonged hospitalization. Given the underlying malleability of the developing brain in early childhood, access to supportive services that facilitate ongoing neurodevelopment in hospitalized young children is of utmost importance; such services further reduce parental stress and likely enhances parental and medical team efficacy of care.

Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review

BACKGROUND

Adopted children and children placed in foster care are at increased risk of developing a range of mental health, behavioural, and psychosocial adjustment problems. Previous studies suggest that due to early experiences of separation and loss some children may have difficulties forming a secure attachment relationship with the adoptive/foster parents.

OBJECTIVES

The objectives of the present review were: (1) to assess the efficacy of attachment-based interventions on measures of favourable parent/child outcomes (attachment security, dyadic interaction, parent/child psychosocial adjustment, behavioural and mental health problems, and placement breakdown) within foster and adoptive families with children aged between 0 and 17 years. (2) to identify factors that appear to be associated with more effective outcomes and factors that modify intervention effectiveness (e.g., age of the child at placement and at intervention start, programme duration, programme focus).

SEARCH METHODS

Relevant studies were identified through electronic searches of bibliographic databases, governmental and grey literature repositories, hand search in specific targeted journals, citation tracking, contact to international experts and Internet search engines. The database searches were carried out to October 2020.

SELECTION CRITERIA

The interventions of interest were parenting interventions aimed at helping the foster/adopted children and their parents to form or sustain a secure attachment relationship. The interventions had to be at least partly informed by attachment theory.

DATA COLLECTION AND ANALYSIS

The total number of potentially relevant studies constituted 17.822 hits after duplicates were removed. A total of 44 studies (27 different populations) met the inclusion criteria and were critically appraised by the review authors. Due to critical study quality, missing numeric data and re-use of the same data, only 24 studies analysing 16 different populations could be used in the data synthesis (children, N = 1302; parents, N = 1344). Meta-analysis using both child and parent outcomes were conducted on each metric separately. All analyses were inverse variance weighted using random effects statistical models. Random effects weighted mean effect sizes were calculated using 95% confidence intervals (CIs). When possible, we conducted moderator analysis using meta-regression and single factor sub group moderator analysis. Sensitivity analysis were conducted across study design and domains of the risk of bias assessment.

MAIN RESULTS

Ten studies analysed the effect of attachment-based interventions on the overall psychosocial adjustment of foster or adopted children as reported by their caregivers post intervention. Measures used include the Child Behaviour Checklist, The Strengths and Difficulties Questionnaire, Brief Infant-Toddler Social and Emotional Assessment (BITSEA) and Eyberg Child Behaviour Inventory. The random effects weighted standardised mean difference (SMD) favouring the intervention group was 0.37 (95% CI, 0.10-0.65) and statistically significant. Three studies analysed the effects of attachment-based interventions on the observed attachment security of foster and adopted children as measured by independent observation. Measures include the Strange Situation Procedure, Attachment Q-Set, and The Emotional Availability Clinical Screener. The random effects weighted SMD was 0.59 (95% CI, -0.40-1.57) and not statistically significant. Four studies analysed the effect of attachment-based interventions on positive child behaviour post intervention as measured by independent observation of video-taped interaction between the child and caregivers. Measures include Disruptive Behaviour Diagnostic Observation Schedule (DB-DOS) and Emotional Availability Scales). The random effects weighted SMD was 0.39 (95% CI, 0.14-0.64) and statistically significant. Ten studies analysed the effect of attachment-based interventions on positive parenting behaviour post intervention as measured by independent observation of video-taped interaction between the child and caregivers or coding of audio-taped recordings of parental speech. Measures include Adapted Ainsworth Scales for sensitivity and noninterference, Measurement of Empathy in Adult-Child Interaction, The Dyadic Parent-Child Interaction Coding System, Reflective functioning scale, and Emotional Availability Scales. The random effects weighted SMD was 1.56 (95% CI, 0.81-2.31) and statistically significant. Nine studies analysed the effect of attachment-based interventions on self-reported post intervention parenting stress (Parenting Stress Index). The random effects weighted SMD was 0.24 (95% CI, 0.03-0.46.) and statistically significant. Three studies analysed the effect of attachment-based interventions on parental post intervention self-reported depressive symptoms (Beck Depression Inventory). The random effects weighted SMD was 0.59 (95% CI, -0.08-1.25.) and not statistically significant. Follow-up analyses were carried out for the outcomes externalising behaviour, positive parenting, and parenting stress, but due to the low number of studies, results should be viewed with caution. Results of the single factor sub group moderator analysis suggest that it cannot be ruled out the effects differ depending on whether the interventions take place in the family home or in a clinical setting. However, it is unclear which location is associated with more positive effects as our findings differ between child and parent outcomes. Results of the sensitivity analysis showed no appreciable changes in the results following the removal of any of the studies in any of the analyses.

AUTHORS' CONCLUSIONS

Parenting interventions based on attachment theory increase positive parent/child interactional behaviours, decrease parenting stress, and increase the overall psychosocial adjustment of children in foster and adoptive families postintervention. Due to the low number of studies evidence regarding the effects of attachment-based parenting interventions on attachment security and disorganised attachment in foster and adopted children was inconclusive. Theoretically, it is possible that child attachment security and/or attachment disorganisation cannot change within the relatively short period of time that parenting interventions typically last. It is possible that if postintervention improvements in parenting behaviours are sustained over time, it may lead to possible improvement in child attachment security and a decrease in child disorganised attachment. Thus, more longitudinal research is needed. Furthermore, evidence regarding the long-term effects of attachment-based parenting interventions on any outcomes was inconclusive due to too few studies, but findings suggest that attachment-based interventions increase positive parenting behaviour at follow-up points 3-6 months after the intervention. No study included in the present review provided a measure of placement stability or breakdown as an outcome, which could be used in the meta-analysis. This further emphasises the need for future longitudinal research in prevention of placement breakdown.

Adverse childhood experiences (ACEs) associated with reduced cognitive flexibility in both college and community samples

The prefrontal cortex is sensitive to stress experiences and significantly impacted by early life adversity. Cognitive flexibility is an executive function that is associated with positive outcomes in adulthood and implicated in activity in the prefrontal cortex. The relationship between early life adversity and cognitive flexibility is underreported. Using the cumulative risk model, we conducted two studies to examine the association between early life adversity and cognitive flexibility in college students and adults (cumulative N = 510). Exposure to early life adversity was assessed using the adverse childhood experiences scale (ACEs). Cognitive flexibility was assessed using the Wisconsin Card Sorting Test (WCST). Additionally, as perceived chronic stress is associated with impaired prefrontal cortex function, we measured that as well. Higher number of ACEs was correlated with lower number of completed categories on the WCST in both college students and adults. Perceived chronic stress was not associated with cognitive flexibility, but did correlate positively with ACEs. Individuals with a higher number of ACEs were also more likely to report higher levels of perceived chronic stress. Hierarchical regression analyses indicated that exposure to adverse childhood experiences predicted lower scores on completed categories. Our findings provide further evidence that individuals with early life adversity exhibit reduced cognitive flexibility in adulthood.

Associations of Early-Life Threat and Deprivation With Executive Functioning in Childhood and Adolescence: A Systematic Review and Meta-analysis

IMPORTANCE

Many studies have demonstrated an association between early-life adversity (ELA) and executive functioning in children and adolescents. However, the aggregate magnitude of this association is unknown in the context of threat and deprivation types of adversity and various executive functioning domains.

OBJECTIVE

To test the hypothesis that experiences of deprivation are more strongly associated with reduced executive functioning compared with experiences of threat during childhood and adolescence.

DATA SOURCES

Embase, ERIC, MEDLINE, and PsycInfo databases were searched from inception to December 31, 2020. Both forward and reverse snowball citation searches were performed to identify additional articles.

STUDY SELECTION

Articles were selected for inclusion if they (1) had a child and/or adolescent sample, (2) included measures of ELA, (3) measured executive functioning, (4) evaluated the association between adversity and executive functioning, (5) were published in a peer-reviewed journal, and (6) were published in the English language. No temporal or geographic limits were set. A 2-reviewer, blinded screening process was conducted.

DATA EXTRACTION AND SYNTHESIS

PRISMA guidelines were used to guide data extraction and article diagnostics (for heterogeneity, small study bias, and p-hacking). Article quality was assessed, and data extraction was performed by multiple independent observers. A 3-level meta-analytic model with a restricted maximum likelihood method was used. Moderator analyses were conducted to explore heterogeneity.

MAIN OUTCOMES AND MEASURES

Primary outcomes included measures of the 3 domains of executive functioning: cognitive flexibility, inhibitory control, and working memory.

RESULTS

A total of 91 articles were included, representing 82 unique cohorts and 31 188 unique individuals. Deprivation, compared with threat, was associated with significantly lower inhibitory control (F1,90 = 5.69; P = .02) and working memory (F1,54 = 5.78; P = .02). No significant difference was observed for cognitive flexibility (F1,36 = 2.38; P = .12). The pooled effect size of the association of inhibitory control with deprivation was stronger (Hedges g = -0.43; 95% CI, -0.57 to -0.29) compared with threat (Hedges g = -0.27; 95% CI, -0.46 to -0.08). The pooled effect size of the association of working memory with deprivation was stronger (Hedges g = -0.54; 95% CI, -0.75 to -0.33) compared with threat (Hedges g = -0.28; 95% CI, -0.51 to -0.05).

CONCLUSIONS AND RELEVANCE

Experiences of both threat and deprivation in childhood and adolescence were associated with reduced executive functioning, but the association was stronger for exposure to deprivation. Efforts to address the consequences of ELA for development should consider the associations between specific dimensions of adversity and specific developmental outcomes.

Adapting an Evidence-Based Home Visiting Intervention for Mothers With Opioid Dependence: Modified Attachment and Biobehavioral Catch-up

Infants born to mothers who are dependent on opioids often have difficulty regulating behavior and physiology at birth. Without sensitive maternal care, these infants are at risk for ongoing problems with self-regulation. Mothers who are dependent on opioids may experience challenges related to their substance use (e.g., unsupportive and/or risky environment, impulse control and reward system problems) that increase the likelihood of insensitive parenting in the absence of effective intervention. In this paper, we describe a home-visiting intervention we have adapted to enhance sensitive, responsive caregiving tailored to the specific needs of mothers with opioid dependence. The original intervention, Attachment and Biobehavioral Catch-up (ABC), was designed for mothers of infants aged 6-24 months who were exposed to early adversity. ABC has been shown to enhance sensitive parenting as well as children's behavioral and biological functioning, with positive outcomes extending into at least middle childhood. Mothers who are opioid dependent need earlier support than provided by ABC because opioid-exposed infants are often vulnerable at birth. The adapted intervention (modified ABC or mABC) includes one prenatal session and one early postnatal session, followed by 10 sessions every 2-3 weeks. In the initial two sessions in particular, mothers are helped to anticipate the challenges of caring for a baby who may be difficult to soothe while nonetheless providing sensitive care. mABC is intended to help mothers see the importance of responding sensitively so as to help infants overcome the developmental risks associated with opioid exposure. Additionally, mABC is structured to support mothers with the challenges of early parenting, especially if the mother herself was not parented sensitively. Throughout, the focus is on helping the mother nurture the distressed infant, attend to the infant's signals, and avoid behaving in overstimulating or intrusive ways. Case examples are presented that highlight both the challenges of working with this population as well as the gains made by mothers.

ADHD Symptomatology, Executive Function and Cognitive Performance Differences between Family Foster Care and Control Group in ADHD-Diagnosed Children

Children in foster care have a high prevalence of attention deficit and hyperactivity disorder (ADHD) diagnosis, together with other difficulties in inattentive/hyperactive behaviors, executive and cognitive processes. Early exposure to adversity is a risk factor for developing ADHD via neurodevelopmental pathways. The goal of this research is (a) to study the cognitive and executive performance and inattentive/hyperactive behavior of ADHD-diagnosed children living in foster families in Spain, and (b) to analyze the role of placement variables in their performance. The sample was composed of 102 ADHD-diagnosed children aged 6- to 12-years-old, divided into two groups: 59 children living with non-relative foster families and 43 children not involved with protection services. Children’s executive function–inhibition, working memory, flexibility, attention, intellectual capacity, verbal comprehension, perceptive reasoning, working memory and processing speed were assessed using objective testing measures. At the same time, parents and teachers reported on children’s inattentive, hyperactive and impulsive behaviors. Children in foster care obtained lower scores in the general ability index than the control group after controlling the age at assessment. However, no differences were found in executive processes. Regarding placement factors, children with shorter exposure to adversities in their birth families and more time in foster care showed better executive performance. Professionals should consider the placement history of children in foster care and its influence on their symptomatology and cognitive capacities.

Early parenting intervention accelerates inhibitory control development among CPS-involved children in middle childhood: A randomized clinical trial

Children at risk for neglect or abuse are vulnerable to delays in inhibitory control development. Prior findings suggest that early parenting interventions that target parental sensitivity and responsiveness during infancy can improve executive function outcomes of high-risk children during preschool years; however, little is known about how persistent these gains are through middle childhood. Participants included 76 CPS-involved children who were randomly assigned to either the ABC intervention (N = 32) or the Developmental Education for Families (DEF) control intervention (N = 44), and 53 low-risk children. Children completed the Stop Signal Reaction Time (SSRT) paradigm at ages 8 and 10. Intervention group predicted performance on the SSRT at age 8 such that children who received the ABC intervention and children in the low-risk group performed significantly better than children who received the DEF intervention (ABC vs. DEF: Cohen's d = 0.92; low-risk group vs. DEF: d = 0.56). The performances of the ABC and the low-risk groups were not statistically different. There were no significant group differences in SSRT performance at age 10. These findings demonstrate that the ABC intervention has long-term beneficial effects on inhibitory control development in children with a history of early caregiving adversity. A video abstract of this article can be viewed at https://youtu.be/P9oLyfo7pYA.

The importance of responsive parenting for vulnerable infants

The quality of the early caregiving context sets the stage for the developing child's long term developmental trajectory. Infants are born highly dependent on parents and other caregivers for critical input for developing brain and behavioral systems. When infants experience early adversity, they are at risk for difficulties regulating behavior, emotions, and physiology. Parenting interventions have been developed to enhance parental responsiveness, thereby enhancing child outcomes. One such program, Attachment and Biobehavioral Catch-up (ABC), is a home visiting intervention designed to enhance parenting nurturance and sensitivity. In this paper, we will consider the importance of parental sensitivity and developmental consequences of sensitive and insensitive care. We will then describe interventions that target parental responsiveness and intervention effectiveness, focusing primarily on ABC. Public policy recommendations related to the importance of parental responsiveness will then be discussed.

Longitudinal Outcomes of Child Parent Psychotherapy: Response to Commentaries

In response to the commentaries provided by Chu et al. (2020), Harmon et al. (2020), and McMahon & Maxwell (2020) on our longitudinal follow-up of Child-Parent Psychotherapy (CPP) with mothers with depression and their children, we focus on two domains: accessibility and scalability of CPP and identifying empirically supported mechanisms of change in attachment intervention research. In considering the accessibility and scalability of CPP, we discuss issues related to attrition, length of intervention, and implementation with caregivers with depression. Our discussion of mechanisms of change in attachment interventions explores active comparison conditions, theorized mediators, intervention modalities, assessment methods, and longitudinal research designs. This conversation is intended to highlight important areas for future research in the field of attachment interventions, with the goal of informing clinical and systems-level policies and practices.

Increasing secure base script knowledge among parents with Attachment and Biobehavioral Catch-up

This study evaluated whether Attachment and Biobehavioral Catch-up (ABC), a parenting intervention, altered the attachment representations of parents (average age of 34.2 years) who had been referred to Child Protective Services (CPS) due to risk for child maltreatment when their children were infants. Approximately 7 years after completing the intervention, parents who had been randomized to receive ABC (n = 43) exhibited greater secure base script knowledge than parents who had been randomized to receive a control intervention (n = 51). Low-risk parents (n = 79) exhibited greater secure base script knowledge than CPS-referred parents who had received a control intervention. However, levels of secure base script knowledge did not differ between low-risk parents and CPS-referred parents who had received the ABC intervention. In addition, secure base script knowledge was positively associated with parental sensitivity during interactions with their 8-year-old children among low-risk and CPS-referred parents. Mediational analyses supported the idea that the ABC intervention enhanced parents' sensitivity 7 years later indirectly via increases in parents' secure base script knowledge.

Enhancing diurnal cortisol regulation among young children adopted internationally: A randomized controlled trial of a parenting-based intervention

Children who have been adopted internationally commonly experience institutional care and other forms of adversity prior to adoption that can alter the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. In particular, internationally adopted children tend to have blunted diurnal declines compared to children raised in their birth families. The Attachment and Biobehavioral Catch-Up (ABC) intervention was developed to enhance young children's biological and behavioral regulation by promoting sensitive parenting. The current study used a randomized controlled trial to assess whether ABC improved the diurnal functioning of the HPA axis among 85 children who had been adopted internationally when they were between the ages of 4 and 33 months (M = 16.12). Prior to the intervention, there were no significant differences in diurnal cortisol production between children whose parents were randomly assigned to receive ABC and children whose parents were randomly assigned to receive a control intervention. After the intervention, children whose parents had received the ABC intervention exhibited steeper declines in cortisol levels throughout the day than children whose parents had received the control intervention. These results indicate that the ABC intervention is effective in enhancing a healthy pattern of diurnal HPA axis regulation for young children who have been adopted internationally.

Caregiving adversity during infancy and preschool cognitive function: adaptations to context?

From a conditional adaptation vantage point, early life caregiving adversity likely enhances aspects of cognition needed to manage interpersonal threats. Yet, research examining early life care and offspring cognition predominantly relies upon experiments including affectively neutral stimuli, with findings generally interpreted as "early-life caregiving adversity is, de facto, 'bad' for cognitive performance." Here, in a Southeast Asian sample, we examined observed maternal sensitivity in infancy and cognitive performance 3 years later as preschoolers took part in three tasks, each involving both a socioemotional (SE) and non-socioemotional (NSE) version: relational memory (n = 236), cognitive flexibility (n = 203), and inhibitory control (n = 255). Results indicate the relation between early life caregiving adversity and memory performance significantly differs (Wald test = 7.67, (1), P = 0.006) depending on the SE versus NSE context, with maternal sensitivity in infancy highly predictive of worse memory for SE stimuli, and amongst girls, also predictive of better memory when NSE stimuli are used. Results concerning inhibitory control, as well as cognitive flexibility in girls, also tentatively suggest the importance of considering the SE nature of stimuli when assessing relations between the caregiving environment and cognitive performance. As not all approaches to missing data yielded similar results, implications for statistical approaches are elaborated. We conclude by considering how an adaptation-to-context framework approach may aid in designing pedagogical strategies and well-being interventions that harness pre-existing cognitive strengths.

The application of positive parenting interventions to academic school readiness: A scoping review

BACKGROUND

Positive parenting interventions were traditionally developed for use in infant and preschool mental health. However, there is increasing application to a broader range of developmental outcomes. A scoping review was conducted to map the landscape of the diverse applications of positive parenting interventions to academic school readiness.

METHODS

Positive parenting interventions that took place in the early childhood period (prenatal to 6 years) and included an assessment of academic readiness were eligible (i.e., problem-solving/reasoning, language, executive functions and preacademics). The search strategy included four electronic databases from inception to July 2020 and backward/forward searching of the majority of eligible studies. Data charting was completed by double, independent reviewers and included theoretical frameworks, academic readiness outcomes, parenting behaviour targets, populations serviced and methodological approaches used. The synthesis included quantitative descriptives and tabular/visual representations.

RESULTS

Ninety-nine studies met eligibility criteria. There has been a steady increase in published studies since 2005, with each academic readiness skill represented in varying proportions. Attachment theory was the most commonly referenced framework for applying interventions to academic readiness, with a more recent shift towards biobehavioural frameworks. The majority of studies included parental responsiveness as a parent behaviour target, whereas behavioural management was more commonly used with older children and/or those with social-emotional/behavioural difficulties. Most studies used a selective prevention approach, with low socioeconomic families being the most frequently studied group. Research gaps were identified in the measurement of follow-up and parenting behaviour.

CONCLUSION

We discuss changing conceptualizations of academic readiness, applications to public health and practice, and future directions in research.

Pathways to social-emotional functioning in the preschool period: The role of child temperament and maternal anxiety in boys and girls

Individual differences in social-emotional functioning emerge early and have long-term implications for developmental adaptation and competency. Research is needed that specifies multiple early risk factors and outcomes simultaneously to demonstrate specificity. Using multigroup longitudinal path analysis in a sample of typically developing children (N = 541), we examined child temperament dimensions (surgency, negative affectivity, and regulation/effortful control) and maternal anxiety in infancy and age 2 as predictors of child externalizing, internalizing, dysregulation, and competence behaviors at age 3. Four primary patterns emerged. First, there was stability in temperament dimensions and maternal anxiety from infancy to age 3. Second, negative affectivity was implicated in internalizing problems and surgency in externalizing problems. Third, effortful control at age 2 was a potent mediator of maternal anxiety in infancy on age 3 outcomes. Fourth, there was suggestive evidence for transactional effects between maternal anxiety and child effortful control. Most pathways operated similarly for boys and girls, with some differences, particularly for surgency. These findings expand our understanding of the roles of specific temperamental domains and postnatal maternal anxiety in a range of social-emotional outcomes in the preschool period, and have implications for efforts to enhance the development of young children's social-emotional functioning and reduce risk for later psychopathology.

Preliminary indications that the Attachment and Biobehavioral Catch-up Intervention alters DNA methylation in maltreated children

Maltreatment during development is associated with epigenetic changes to the genome. Enhancing caregiving may mitigate these effects. Attachment and Biobehavioral Catch-Up (ABC) is an intervention that has been shown to improve parent-child relationships and a variety of biological and behavioral outcomes among children that are involved in Child Protective Services. This preliminary study, using a small sample size, explored whether children who received ABC exhibit different methylation patterns than those who received a control intervention. The participants included 23 children aged 6-21 months who were randomized to receive ABC (n = 12) or a control intervention (n = 11). While the children displayed similar methylation patterns preintervention, DNA methylation varied between the ABC and control groups at 14,828 sites postintervention. Functional pathway analyses indicated that these differences were associated with gene pathways that are involved in cell signaling, metabolism, and neuronal development. This study is one of the first to explore parenting intervention effects on children's DNA methylation at the whole genome level in infancy. These preliminary findings provide a basis for hypothesis generation in further research with larger-scale studies regarding the malleability of epigenetic states that are associated with maltreatment.

Heterogeneity in the dynamic arousal and modulation of fear in young foster children

Guided by emotional security theory, we explored how child and context-related factors were associated with heterogeneity in young foster children's organized patterns of fear response to distress. Results from group-based trajectory modeling used to analyze observational data from a fear-eliciting task showed that children from our sample (mean age = 62 months, SD = 9) were classified into 3 specific fear regulation patterns differentiated by the emotional response parameters of onset intensity, peak intensity, and rise time. A descriptive examination of child's emotion knowledge, aggressive behaviors, and attention problems, as well as length of time in current foster home, placement transitions, and caregiver responsiveness and modeling showed class-specific differences in means. Moreover, the likelihood of class membership was significantly predicted by children's emotion knowledge, aggressive behaviors, and foster mothers' responsiveness and modeling of appropriate boundaries. Results show promising support for the implementation of individualized, child-directed interventions targeting specific patterns of response parameters of emotion regulation for young foster children. Further, parenting intervention services need to promote the emotion socialization skills of foster parents that are tailored toward each specific trajectory pattern of emotion arousal and modulation.

Early Parenting Intervention Effects on Brain Responses to Maternal Cues Among High-Risk Children

OBJECTIVE

Early adversity is correlated with increased risk for negative outcomes, including psychopathology and atypical neurodevelopment. The authors aimed to test the causal impact of an early parenting intervention (Attachment and Biobehavioral Catch-Up; ABC) on children's neural processing of parent cues and on psychosocial functioning in a longitudinal randomized clinical trial.

METHODS

Participants (N=68, mean age, 10.0 years [SD=0.8 years]) were 46 high-risk children whose parents were randomly assigned to receive either the ABC intervention (N=22) or a control intervention (N=24) while the children were infants, in addition to a comparison sample of low-risk children (N=22). During functional MRI scanning, children viewed pictures of their own mothers and of a stranger.

RESULTS

Children in the ABC condition showed greater maternal cue-related activation than children in the control condition in clusters of brain regions, including the precuneus, the cingulate gyrus, and the hippocampus, regions commonly associated with social cognition. Additionally, greater activity in these regions was associated with fewer total behavior problems. There was an indirect effect of early intervention on middle childhood psychosocial functioning mediated through increased activity in brain regions in response to maternal cues.

CONCLUSIONS

These results suggest that early parenting intervention (in this case the ABC intervention) can enhance brain regions supporting children's social cognitive development. In addition, the findings highlight these brain effects as a possible neural pathway through which ABC may prevent future behavior problems among high-risk children, yielding psychosocial benefits that endure through at least middle childhood without the need to intervene with the child directly.

A randomized controlled trial comparing parent child interaction therapy - toddler, circle of security- parenting™ and waitlist controls in the treatment of disruptive behaviors for children aged 14-24 months: study protocol

BACKGROUND

It is common for toddlers to display disruptive behaviors (e.g., tantrums, aggression, irritability) but when these become severe and persistent they can be the start of a trajectory towards poor outcomes in childhood and adolescence. Parent Child Interaction Therapy - Toddler is an intervention model designed to meet the specific developmental needs of toddlers aged 12-24 months presenting with disruptive behaviors.

METHODS

This study will use a randomized controlled design to evaluate the efficacy of the Parent Child Interaction Therapy - Toddler intervention for children aged 14-24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior will be randomly allocated to either Parent Child Interaction Therapy - Toddler, Circle of Security- Parenting™ or a waitlist control group. Key parenting capacity outcome variables will include positive and negative parenting, parenting sensitivity, parental sense of competence in managing negative toddler emotions, parent sense of caregiving helplessness, parent mentalizing about the child, parent emotion regulation, child abuse potential and parental stress. Key outcome variables for children will include child social-emotional functioning (initiative, relationship functioning, self-regulation), child emotion regulation, child attachment security, and child behavior.

DISCUSSION

Delivered in the early intervention period of toddlerhood, Parent Child Interaction Therapy - Toddler has the potential to bring about significant and lasting changes for children presenting with early onset behavioral issues.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR), 12618001554257 . Registered 24 September 2018 - retrospectively registered.

Intervening with Attachment and Biobehavioral Catch-Up to decrease disrupted parenting behavior and attachment disorganization: The role of parental withdrawal

This randomized controlled trial investigated the efficacy of Attachment and Biobehavioral Catch-up (ABC; Dozier, Bick, & Bernard, 2011) in reducing disrupted parenting behavior (affective communication errors, role/boundary confusion, fearful/disoriented, intrusive/negativity, and withdrawal) and its association with disorganized attachment. Participants were 105 mother-child dyads randomized to receive either ABC or a control intervention (a 10-session home-visiting intervention focused on improving children's cognitive abilities, gross and fine motor abilities, and language development). At the time of study enrollment, mothers were approximately 26.7 years old (SD = 7.8) and predominantly Black or African American (73.9%). At the first follow-up visit, children were approximately 20.7 months old (SD = 6.3) and most were identified as Black or African American (61.9%). Fifty-two percent of children were male (n = 55). Assessments of disrupted parenting behavior and child attachment quality were assessed approximately 7 months postintervention (SD = 5.8). A one-way analysis of variance revealed that parents who received ABC demonstrated lower levels of parental withdrawal than parents who received the control condition. A structural equation model revealed a significant indirect effect of intervention group on attachment quality through lower levels of parental withdrawal. Results add to the efficacy of the ABC intervention and identified parental withdrawal as a mediator of change.

Changing parental depression and sensitivity: Randomized clinical trial of ABC's effectiveness in the community

Attachment and Biobehavioral Catch-up (ABC) demonstrates efficacy in improving parent and child outcomes, with preliminary evidence for effectiveness in community settings. The objective of this study was to assess the effectiveness of a community-based ABC implementation in improving parent outcomes as well as to examine potential mediators and moderators of intervention effectiveness. Two hundred parents and their 5- to 21-month-old infants recruited from an urban community were randomly assigned to receive ABC or be placed on a waitlist. The majority of participants had a minority racial or ethnic background. Before intervention, parents completed questionnaires about sociodemographic risk and adverse childhood experiences. At both baseline and follow-up, parents reported depression symptoms and were video-recorded interacting with their infant, which was coded for sensitivity. The ABC intervention predicted significant increases in parental sensitivity and, among parents who completed the intervention, significant decreases in depression symptoms. Changes in parental depression symptoms did not significantly mediate the intervention effects on sensitivity. Risk variables did not moderate the intervention effects. The results indicate that ABC shows promise for improving parent outcomes in community settings, supporting dissemination.

Changes in provider Fidelity after introducing a new model of intervention

Given the impact of implementation fidelity on community-based outcomes, it is important to understand how fidelity may change over time as providers learn an intervention. Attachment and Biobehavioral Catch-up is an evidence-based early intervention that assesses fidelity during weekly supervision. Providers are first trained in the infant model, with toddler model training considered to be a separate, specialized opportunity. The current study examined changes in fidelity, measured by “in-the-moment” commenting, as providers moved from infant to toddler certification. An initial drop, with a subsequent increase, in commenting fidelity over the training year was expected. Results were consistent with our hypotheses, demonstrating a main effect of time, with most indices of commenting data initially decreasing and then increasing. These findings are consistent with research suggesting that fluctuation in fidelity is typical within community dissemination and suggests that ongoing supervision after the initial training is useful in facilitating successful skill development.

Intervening with Attachment and Biobehavioral Catch-Up to decrease disrupted parenting behavior and attachment disorganization: The role of parental withdrawal

This randomized controlled trial investigated the efficacy of Attachment and Biobehavioral Catch-up (ABC; Dozier, Bick, & Bernard, 2011) in reducing disrupted parenting behavior (affective communication errors, role/boundary confusion, fearful/disoriented, intrusive/negativity, and withdrawal) and its association with disorganized attachment. Participants were 105 mother-child dyads randomized to receive either ABC or a control intervention (a 10-session home-visiting intervention focused on improving children's cognitive abilities, gross and fine motor abilities, and language development). At the time of study enrollment, mothers were approximately 26.7 years old (SD = 7.8) and predominantly Black or African American (73.9%). At the first follow-up visit, children were approximately 20.7 months old (SD = 6.3) and most were identified as Black or African American (61.9%). Fifty-two percent of children were male (n = 55). Assessments of disrupted parenting behavior and child attachment quality were assessed approximately 7 months postintervention (SD = 5.8). A one-way analysis of variance revealed that parents who received ABC demonstrated lower levels of parental withdrawal than parents who received the control condition. A structural equation model revealed a significant indirect effect of intervention group on attachment quality through lower levels of parental withdrawal. Results add to the efficacy of the ABC intervention and identified parental withdrawal as a mediator of change.

Promoting Self-Regulation in Young Children: The Role of Parenting Interventions

Self-regulation is a foundational skill in childhood and underpins various positive and negative outcomes throughout childhood, adolescence and into adulthood. Parents and the way they parent their children play a key role in the development of young children's self-regulatory capacity. However, there is limited evidence for the effectiveness of parenting interventions on child self-regulatory outcomes. This paper provides an overview of the role of parenting in the development of child self-regulation and a summary of the evidence base for parenting interventions to promote self-regulation in children under age eight, focusing on infancy, the toddler/preschooler period, and early school-age. We conclude by examining the gaps in this field of research and providing directions for future research.

Early adversity, child neglect, and stress neurobiology: From observations of impact to empirical evaluations of mechanisms

Research on the effects of early life adversity, and in particular on the absence of responsive caregiving, has shown long-term impacts on well-being and development. These investigations have been conducted both in human populations and in animal models. The work has demonstrated that neglect experienced in the early years can affect not only behavior but also neurobiological functioning. In particular, studies of children in the foster care system show convergence with research on children adopted following institutional rearing in terms of dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which produces the neuroendocrine hormone cortisol. The characteristic pattern that has been most commonly observed involves diminished diurnal cortisol production, particularly in terms of low levels of cortisol upon awakening. Notably, however, a number of evidence-based interventions for infant, toddler, and preschool-aged foster children have been shown to produce more typical patterns of cortisol production, in combination with improved behavioral, socioemotional, and foster care placement outcomes. In this paper, we review the literature on the effects of early disruptions in care on biobehavioral development, and summarize the results of the interventions for young foster children.

Perinatal depression, PTSD, and trauma: Impact on mother-infant attachment and interventions to mitigate the transmission of risk

Early interactions between infants and their caregivers are fundamental to child development, and the parent-infant relationship is believed to provide the foundation for healthy and secure attachment relationships and for infant mental health. Over time, these secure attachment relationships become the backbone for positive child outcomes across development. Abundant research to date confirms that parental mental illness, including depression and PTSD following trauma exposure, may have a detrimental impact on parenting quality and subsequent early child relationship formations. This review paper summarizes the literature on the role of sensitive parenting and a healthy mother-infant relationship in establishing a secure mother-infant attachment bond, which in turn is critical for the child's healthy socioemotional and cognitive development. The review also highlights the roles of maternal perinatal depression, PTSD, and/or exposure to interpersonal violence or childhood maltreatment onto parenting, bonding, and child attachment style towards the caregiver. The final section discusses existing therapeutic interventions and approaches that bolster early parenting practices and early maternal-child relationships. Specific emphasis is placed on relational interventions that address bonding and attachment disturbances in the context of maternal perinatal mental health risk and trauma.

Cognitive Flexibility Training Improves Extinction Retention Memory and Enhances Cortical Dopamine With and Without Traumatic Stress Exposure

Stress exposure can cause lasting changes in cognition, but certain individual traits, such as cognitive flexibility, have been shown to reduce the degree, duration, or severity of cognitive changes following stress. Both stress and cognitive flexibility training affect decision making by modulating monoamine signaling. Here, we test the role cognitive flexibility training, and high vs. low cognitive flexibility at the individual level, in attenuating stress-induced changes in memory and monoamine levels using the single prolonged stress (SPS) rodent model of traumatic stress in male Sprague-Dawley rats. Exposure to SPS can heighten fear responses to conditioned cues (i.e., freezing) after a fear association has been extinguished, referred to as a deficit in extinction retention. This deficit is thought to reflect an impairment in context processing that is characteristic of posttraumatic stress disorder (PTSD). During a cognitive flexibility training we assessed individual variability in cognitive skills and conditioned rats to discriminately use cues in their environment. We found that cognitive flexibility training, alone or followed by SPS exposure, accelerated extinction learning and decreased fear responses over time during extinction retention testing, compared with rats not given cognitive flexibility training. These findings suggest that cognitive flexibility training may improve context processing in individuals with and without traumatic stress exposure. Individual performance during the reversal phase of the cognitive flexibility training predicted subsequent context processing; individuals with high reversal performance exhibited a faster decrease in freezing responses during extinction retention testing. Thus, high reversal performance predicted enhanced retention of extinction learning over time and suggests that cognitive flexibility training may be a strategy to promote context processing. In a brain region vital for maintaining cognitive flexibility and fear suppression, the prelimbic cortex (PLC), cognitive flexibility training also lastingly enhanced dopamine (DA) and norepinephrine (NE) levels, in animals with and without traumatic stress exposure. In contrast, cognitive flexibility training prior to traumatic stress exposure decreased levels of DA and its metabolites in the striatum, a region mediating reflexive decision making. Overall, our results suggest that cognitive flexibility training can provide lasting benefits by enhancing extinction retention, a hallmark cognitive effect of trauma, and prelimbic DA, which can maintain flexibility across changing contexts.

Promoting Compliance in Children Referred to Child Protective Services: A Randomized Clinical Trial

Early experiences of maltreatment have long-term negative effects on children's compliance. This randomized clinical trial examined whether a brief preventative intervention (Attachment and Biobehavioral Catch-up; ABC) was effective in enhancing compliance in children who had been referred to Child Protective Services. Participants included 101 parent-child dyads who received either ABC or a control intervention when children were infants (M = 9.4 months old, SD = 6.1). When children were approximately 36 months old (M = 38.5, SD = 3.0), ABC children demonstrated significantly better compliance than control children. Further, parent sensitivity, measured 1 month post intervention when children were, on average, 18.4 months old (SD = 6.9) partially mediated the effect of ABC on child compliance at 36 months old.

ATTACHMENT AND BIOBEHAVIORAL CATCH-UP: A SYSTEMATIC REVIEW

Attachment Biobehavioral Catch-up (ABC; Dozier et al., 2006) is a 10-week, in-home intervention primarily for early childhood aged children (ages 6 months-2 years). The ABC intervention seeks to teach parents how to provide nurturing care and engage in appropriate interactions with their children. ABC has been identified as a Level 1 evidence-based practice by the California Evidence-Based Clearinghouse for Child Welfare. However, to date, there has been no systematic review presenting the overall evidence behind ABC available in a peer-reviewed journal. The objective of this review is to address this gap by synthesizing prior literature and evidence, specifically evidence from randomized control trials (RCTs), regarding the effectiveness of the ABC intervention and to determine the contexts in which the intervention has been implemented. To complete this review, literature was searched across three bibliographic databases and relevant Web sites. Only RCTs examining child outcomes were included in the review. Using identified search procedures, 10 articles discussing RCTs which tested the efficacy of ABC were identified. Findings indicate that ABC is effective, when implemented with child-welfare-involved children, at improving emotion regulation, improving externalizing and internalizing behaviors, increasing normative developmental functioning, and attachment quality. Sample information from the 10 RCTs identified is presented as well as additional study characteristics.

Enhancing the language development of toddlers in foster care by promoting foster parents' sensitivity: Results from a randomized controlled trial

Young children in foster care are at increased risk for problematic language development, making early intervention a critical tool in enhancing these children's foundational language abilities. This study examined the efficacy of an early preventative intervention, Attachment and Biobehavioral Catch-up for Toddlers (ABC-T), in improving the receptive vocabulary abilities of toddlers placed in foster care. All the children had been removed from their biological parents' care and placed into foster care. When children were between 24 and 36 months old, foster parents were contacted by research staff and consented to participate. Parents were randomly assigned using a random number generator to receive either ABC-T (n = 45), which aimed to promote sensitive parenting for children who have experienced early adversity, or a control intervention (n = 43). Foster children's receptive vocabulary skills were assessed post-intervention using the Peabody Picture Vocabulary Test, Third Edition, when children were between 36 and 60 months old. Children whose foster parents received ABC-T demonstrated more advanced receptive vocabulary abilities than children whose foster parents received the control intervention. The positive effect of ABC-T on foster children's receptive vocabulary was mediated by increases in foster parents' sensitivity during parent-child interactions. Trial registration: ClinicalTrials.gov NCT01261806.

Attachment, Development, and Mental Health in Abused and Neglected Preschool Children in Foster Care: A Meta-Analysis

A proper preparation for foster parents to care for abused and neglected children includes effective training and initial diagnostics in order to plan individual treatment. Hence, a basic knowledge about the main psychosocial and developmental problems associated with abuse and neglect and their prevalence in foster children is needed. For this purpose, a systematical literature review and a series of meta-analyses were conducted. A total of 25 studies reporting data on development ( n = 4,033), mental health ( n = 726), and attachment ( n = 255) of foster children in preschool age met the inclusion criteria. The meta-analyses indicated prevalence rates of approximately 40% for developmental, mental health problems, and insecure attachment. Rates of disorganized attachment were estimated to 22%. These findings outline the necessity of an initial trauma-oriented diagnostics and trainings for foster parents that address foster children's development, mental health, and disorganized attachment.

Novel Methods for Screening: Contributions from Attachment and Biobehavioral Catch-up

Preventative interventions are needed across the lifespan, including for children who have experienced maltreatment. However, interventions' effect sizes are typically smaller in real-world settings than in clinical trials. Identifying providers who are likely to implement interventions with fidelity could promote implementation outcomes through targeted allocation of training resources. This study tested two pre-training screening measures as predictors of provider fidelity to Attachment and Biobehavioral Catch-up (ABC), a preventative intervention for maltreated infants. One measure assessed valuing of attachment/openness, and the other used vignettes to assess initial skill in a key intervention component. In a sample of 42 providers across 197 sessions, both screening measures predicted future ABC fidelity, even when controlling for experience and education. These results support the development of screening measures for other interventions, suggesting approaches that target specific qualities and behaviors are likely to predict implementation fidelity.

Developing self-regulation in a dysregulating world: Attachment and Biobehavioral Catch-up for a toddler in foster care

Toddlers in foster care have typically experienced histories of maltreatment and disruptions in relationships with primary caregivers. As a result, they are at increased risk for developing disorganized attachment and showing emotional, behavioral, and physiological dysregulation. Attachment and Biobehavioral Catch-up for Toddlers in Foster Care (ABC-T) was developed to address the needs of these vulnerable children by supporting foster parents in responding with nurturance to children's distress, following children's lead, and helping children calm when they are becoming overwhelmed or dysregulated. We describe the theoretical underpinnings, evidence base, and clinical approach of ABC-T. Using a case example of Luna and her foster mother Ms. Rosio, we present the typical course of ABC-T, demonstrating core aspects of the model including ongoing observation of parent-child interactions and "in the moment" commenting. Additionally, we consider several challenges to delivering attachment-based interventions in the context of foster care.

Instrumental learning and cognitive flexibility processes are impaired in children exposed to early life stress

Children who experience severe early life stress show persistent deficits in many aspects of cognitive and social adaptation. Early stress might be associated with these broad changes in functioning because it impairs general learning mechanisms. To explore this possibility, we examined whether individuals who experienced abusive caregiving in childhood had difficulties with instrumental learning and/or cognitive flexibility as adolescents. Fifty-three 14-17-year-old adolescents (31 exposed to high levels of childhood stress, 22 control) completed an fMRI task that required them to first learn associations in the environment and then update those pairings. Adolescents with histories of early life stress eventually learned to pair stimuli with both positive and negative outcomes, but did so more slowly than their peers. Furthermore, these stress-exposed adolescents showed markedly impaired cognitive flexibility; they were less able than their peers to update those pairings when the contingencies changed. These learning problems were reflected in abnormal activity in learning- and attention-related brain circuitry. Both altered patterns of learning and neural activation were associated with the severity of lifetime stress that the adolescents had experienced. Taken together, the results of this experiment suggest that basic learning processes are impaired in adolescents exposed to early life stress. These general learning mechanisms may help explain the emergence of social problems observed in these individuals.

Moving an Evidence-Based Parenting Program Into the Community

Attachment and Biobehavioral Catch-up (ABC) is a parenting program developed to enhance sensitivity among parents of infants who experience early adversity. In several randomized clinical trials, the intervention's efficacy has been demonstrated. Moving interventions into the community with adequate fidelity is challenging, though, and intervention effects are often much smaller than when tested in randomized clinical trials. To enhance the likelihood that ABC is delivered with high fidelity, a microanalytic fidelity assessment was developed. Using this fidelity tool as a central component of training, supervision, and certification, changes in parent sensitivity for 108 families with children ages 6 months to 2 years were as large as those seen in laboratory settings. These findings are discussed with regard to implications for moving other evidence-based interventions into the community.