Toddler negative affectivity and effortful control: Relations with parent-toddler conversation engagement and indirect effects on language.

Evidence that early parent-child conversation supports early language development suggests a need to understand factors that account for individual differences in parent-child conversation engagement. Whereas most studies focus on demographic factors, we investigated the role of toddler temperament in a longitudinal study of 120 economically strained families. Specifically, we investigated the degree to which toddlers' negative affectivity and effortful control, considered together as a composite reflecting challenging temperament, accounted for variability in parent-toddler conversation engagement, and whether the frequency of that engagement mediated associations between toddler temperament and toddler expressive language skills. Toddler challenging temperament (i.e., high negative affectivity and low effortful control) and parent-toddler conversation engagement were measured at 18 and 30 months. Toddler expressive language skills were measured at 18, 24, and 36 months. As expected, a path model indicated inverse relations between toddler challenging temperament and concurrent parent-toddler conversation engagement at both 18 and 30 months. Unexpectedly, there were no direct associations between toddler challenging temperament and toddler expressive language skills either concurrently or longitudinally. However, we found indirect effects of toddler challenging temperament on later toddler expressive language skills via parent-toddler conversation engagement. Findings highlight the importance of considering toddler temperamental characteristics in addition to family demographics as important factors that account for variability in parent-toddler conversation engagement.

Assessing Changes in Parent Sensitivity in Telehealth and Hybrid Implementation of Attachment and Biobehavioral Catch-Up During the COVID-19 Pandemic.

During the COVID-19 pandemic, home visiting services for families with young children pivoted to continue providing services virtually. One such service was Attachment and Biobehavioral Catch-up (ABC), a brief prevention/intervention program targeting increased parental sensitivity. 70 families participated in a sensitivity assessment before and after receiving ABC. Forty-three families received the program fully through telehealth, and 27 families received the program through an in-person/telehealth hybrid format. Parent sensitivity was assessed pre- and post-intervention, and results suggested that when ABC was delivered through a telehealth or hybrid format, parents showed increased following the lead and decreased intrusiveness from pre- to post-intervention, with moderate effect sizes. Ongoing supervision in the model, weekly fidelity maintenance checks, and the flexibility of families and parent coaches likely contributed to the maintenance of significant change in parental sensitivity from pre- to post-intervention during the move from face-to-face home visiting to the provision of virtual services.

Parent Coaching Fidelity Trajectories of In-Person and Telehealth Sessions during the COVID-19 Pandemic.

The COVID-19 pandemic has posed significant challenges to delivery of preventive and mental health services, and providers have rapidly transitioned to telehealth service provision. Factors such as sudden isolation, financial strain, and physical and mental health stress presented unique challenges for providers and families and highlight the need for accessible and effective services. Thus, providers' fidelity of implementation during the pandemic is an important area for research. The current observational study compared providers' fidelity across in-person and telehealth-delivered sessions before and during the COVID-19 pandemic in Attachment and Biobehavioral Catch-up (ABC), a preventive parent coaching intervention for infants and toddlers. Participants included 24 providers (95% female, 42% White, M age = 37) who participated in ABC training and consultation during the COVID-19 pandemic. Providers' fidelity data (N = 593 sessions) were modeled longitudinally using hierarchical linear modeling, and separate intercepts and slopes were estimated for in-person and telehealth-delivered sessions. When data were modeled across all available sessions, results indicated that providers demonstrated improving fidelity over the course of training. When in-person and telehealth-delivered sessions were compared, providers' fidelity in telehealth-delivered ABC sessions was not significantly different from their fidelity in in-person sessions. Providers demonstrated improving fidelity over time in telehealth-delivered sessions. Thus, providers were able to maintain and improve ABC fidelity during the COVID-19 pandemic when provided with implementation support. Rapid transition to telehealth delivery can be successful when ongoing support such as consultation is provided.

Examining Research Domain Criteria (RDoC) constructs for anger expression and regulation in toddlers.

The present study is focused on anger expression and regulation within the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) construct of Frustrative Nonreward. Although previous studies have examined associations between child anger regulation and expression, these studies do not directly address the dynamic processes involved in Frustrative Nonreward using microlongitudinal methods. The current study used data from 561 adopted children, their adoptive parents, and birth parents and aimed to address gaps in the literature by examining: (a) temporal associations between anger expression during a frustrating situation, and behaviors thought to regulate emotions (e.g., attempt-to-escape, support-seeking, distraction, and focus-on-restraint) on a microlongitudinal scale during an arm restraint task assessed at 27 months; (b) birth parent externalizing problems and overreactive parenting by adoptive parents as predictors of child anger expression and moderators of the moment-to-moment associations estimated in Step 1; and (c) longitudinal associations (linear vs. quadratic) between anger expressions and externalizing behaviors at 4.5 years. Findings indicated that children's attempt-to-escape and support-seeking predicted an increase in anger expression in the following 3-s interval, whereas distraction and focus-on-restraint were not associated with changes in anger expression. Furthermore, we found that birth parents' externalizing problems were significantly associated with child anger expression, suggesting heritable influences. Anger expression showed a U-shaped longitudinal association with paternal report of externalizing behaviors at 4.5 years. Taken together, the findings emphasize the significance of integrating microlongitudinal analysis approaches into the RDoC framework, helping to advance our understanding of dynamic processes underlying reactions to Frustrative Nonreward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

Transitioning to telehealth due to COVID-19: Maintaining model fidelity in a home visiting program for parents of vulnerable infants.

Maintaining treatment fidelity when implementing evidence-based interventions is a significant challenge. The inability to deliver in-person services due to the COVID-19 pandemic critically challenged the foundation of implementation fidelity for home visiting programs across the globe. The Attachment and Biobehavioral Catch-Up (ABC) program is an evidence-based home visiting intervention designed to increase sensitivity in parents of infants who have experienced early adversity. ABC's community effectiveness is due to rigorous fidelity monitoring and supervision. Fidelity is measured by microanalytic coding of parenting opportunities and "in-the-moment" commenting, the active ingredient of ABC. In this study, we examined intervention fidelity among parent coaches implementing ABC through telehealth. Random 5-min clips from 510 telehealth ABC session videos conducted by 91 parent coaches at 48 agencies were coded for their frequency and quality of in-the-moment comments. On average, parent coaches were able to exceed in-person commenting fidelity standards when implementing ABC through the telehealth format. The active fidelity monitoring and supervision inherent to ABC's dissemination afforded a smooth transition to implementing ABC through telehealth while adhering to fidelity standards. Procedural and clinical challenges to telehealth implementation are discussed, along with future directions for telehealth program effectiveness.

Mantener la fidelidad al tratamiento cuando se implementan intervenciones con base en la evidencia es un reto significativo. La inhabilidad de ofrecer servicios en persona debido a la pandemia del COVID-19 representó un reto crítico a la base de la fidelidad de implementación para los programas de visitas a casa en el mundo. El programa de Afectividad y Bio-conducta de Ponerse el Día (ABC) es una intervención de visitas a casa con base en la evidencia diseñada para aumentar la sensibilidad en los progenitores de infantes que han experimentado temprana adversidad. La eficacia comunitaria de ABC se debe a la rigurosa inspección y supervisión de la fidelidad (Caron et al., 2016). La fidelidad se mide por medio de codificación micro analítica de las oportunidades de crianza y por el comentario " en el momento," ingrediente activo de ABC. En este estudio, examinamos la fidelidad de intervención entre progenitores entrenadores que implementaban ABC a través de salud a distancia. Segmentos de video de 5 minutos de 510 sesiones de salud a distancia ABC al azar, llevadas a cabo por 91 progenitores entrenadores en 48 agencias se codificaron en cuanto a su frecuencia y calidad de los comentarios del momento. En promedio, los progenitores entrenadores pudieron exceder los estándares de fidelidad de comentarios en persona cuando implementaban ABC a través del formato de salud a distancia. La activa inspección y supervisión de la fidelidad inherente a la divulgación de ABC permitió una transición fluida a la implementación de ABC a través de salud a distancia, manteniendo la adhesión a los estándares de fidelidad. Se discuten los retos de procedimiento y clínicos a la implementación de salud a distancia, junto con futuras directrices para la eficacia de programas de salud a distancia.

Le maintien de la fidélité au traitement en mettant en place des interventions basées sur des données factuelles est un défi important. L'incapacité à offrir des services en personne du fait de la pandémie du Covid19 a présenté un défi critique pour la fondation de la mise en place de la fidélité pour les programmes de visite domicile dans le monde entier. Le programme ABC (selon l'anglais Attachment and Biobehavioral Catch-Up, soit Rattrapage de l'Attachement et Rattrapage Biocomportemental) est une intervention de visites à domicile basée sur des données factuelles conçue pour augmenter la sensibilité chez les parents de bébés ayant fait l'expérience d'une adversité précoce. L'efficacité de la communauté de l'ABC est attribuable à un contrôle rigoureux de la fidélité et de la supervision (Caron et al., 2016). La fidélité est mesurée par un codage micro-analytique des opportunités de parentage et des commentaires "au moment", l'ingrédient actif de l'ABC. Dans cette étude nous avons examiné la fidélité de l'intervention chez les entraîneurs de parents mettant en place l'ABC au travers de la télésanté. Des clips de 5-minute randomisés de 510 sessions vidéos de télésanté ABC faites avec 91 entraîneurs de parents de 48 agences ont été codé pour leur fréquence et la qualité des commentaires "au moment". En moyenne les entraîneurs de parent étaient capables d'excéder les standards de fidélité de commentaire en personne en mettant en place l'ABC au travers du format de télésanté. Le contrôle actif de fidélité et de la supervision propre ã la dissémination de l'ABC a permis une transition facile à la mise en place de l'ABC au travers de la télésanté tout en adhérant aux standards de fidélité. Les défis de procédure et les défis cliniques à la mise en place par télésanté sont discutés ainsi que les directions futures pour l'efficacité du programme par télésanté.

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.

Inherited and Environmental Moderators of Mother-Child Behavioral Contingency and Contingent Negativity at 27 Months.

Previous research has shown that as depressive symptomology increases, mothers tend to show withdrawn or harsh interaction patterns with their children, and the quality of these interaction patterns have subsequently been linked to child behavior problems. However, little research has examined bidirectional influences between mothers and their children, and how these moment-to-moment contingencies differ based on heritable and environmental characteristics. We used data from the Early Growth and Development Study a prospective adoption study to examine how adoptive mothers' depressive symptoms and children's heritable tendencies for negative affectivity interact to predict the quality of mother-child interactions at child age 27-months. Results detected two distinct dyadic interaction patterns. The first was a withdrawn interaction style and was observed in children with a high heritable tendency for negative affect. In that style, mother and child interactions were not contingent upon each other, suggesting a lack of joint engagement. The second was a volatile interaction style, observed in children with a low heritable tendency for negative affect. In these cases, mother and child interactions were highly contingent but negative. Our findings demonstrate essential differences in how dyadic interaction patterns vary according to level of depressive symptomology and heritable tendency for negative affect.

Toddler emotion expressions and emotional traits: Associations with parent-toddler verbal conversation.

The present study examines how toddler emotions may influence their own or their parents' participation in parent-toddler verbal conversation. Limited, indirect evidence suggests that toddler positive emotions may encourage, whereas negative emotions may disrupt, parent-toddler verbal exchanges, but these hypotheses have not been tested directly. We investigated two aspects of toddler emotions- their emotion expressions and their emotional traits- and examined their relations with parent-toddler verbal conversation engagement. In a sample of families with 18-month-olds (N = 120), we used live, unstructured home observations of toddler emotion expressions and spontaneous parent-toddler verbalizations, and collected parent ratings of toddler temperament. We found that less surgent toddlers who expressed more frequent negative emotion attempted fewer verbalizations. Among all toddlers, those expressing positive emotion received more frequent parent verbal responses, and, unexpectedly, more failed parent attempts to engage their toddler in conversation. Parent-initiated conversation was unrelated to toddler emotion expressions or emotional traits. We discuss how best to integrate the study of early emotional and language development from a transactional perspective.

Emotion Regulation among Children in Foster Care Versus Birth Parent Care: Differential Effects of an Early Home-Visiting Intervention.

Children involved with Child Protective Services (CPS) often show worse emotion regulation than non-involved children, with downstream effects on adaptive functioning. The current study uses two randomized control trials, one conducted with foster caregivers and one conducted with birth parents, to investigate the longitudinal effects of caregiver type (foster versus birth parent) and a home-visiting parenting intervention on emotion regulation among young children referred to CPS. Participants were 211 children referred to CPS during infancy or toddlerhood, of whom 120 remained with their birth parents and 91 were placed in foster care. Caregivers were randomly assigned to receive Attachment and Biobehavioral Catch-Up (ABC), a 10-session intervention designed to promote nurturing, sensitive, and non-intrusive caregiving, or a control intervention. Caregiver type moderated the effects of ABC on young children's observed anger dysregulation during a frustrating task at age 2 to 3 years. Among children remaining with their birth parents, children whose caregivers received ABC showed lower anger dysregulation than children whose caregivers received the control intervention. Children placed in foster care showed lower anger dysregulation than children with birth parents regardless of parenting intervention, and additionally showed higher adaptive regulation than children remaining with their birth parents. Adaptive regulation was not significantly associated with parenting intervention or the caregiver by intervention interaction. Results suggest that foster care placement may be protective for emerging emotion regulation skills among young children referred to CPS, and an attachment-based parenting intervention buffers risks of remaining in the home for young children's emotion dysregulation.

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.

Attachment and Biobehavioral Catch-up: An evidence-based intervention for vulnerable infants and their families.

In this paper, we highlight issues we consider key to the development of an evidence-based intervention for the parents of young children who had experienced early adversity. The intervention was initially developed for foster infants, but adapted for infants living with their neglecting parents, then for young children adopted internationally, and finally for toddlers in foster care or living with neglecting birth parents. The intervention and its adaptations share a focus on the importance of providing nurturance to children when they are distressed, and following children's lead when they are not distressed. We approached intervention development from a theoretical position, with attachment theory and stress neurobiology central. But we are, at heart, clinical scientists and have been open to confirmation or disconfirmation of our ideas and hypotheses. In this paper, we describe our approach, discuss issues and challenges central to our work, and share advice for addressing similar issues and challenges.

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.

Enhancing executive functioning among toddlers in foster care with an attachment-based intervention.

Young children in foster care often experience adversity, such as maltreatment and lack of stability in early caregiving relationships. As a result, these children are at risk for a range of problems, including deficits in executive functioning. The Attachment and Biobehavioral Catch-up for Toddlers (ABC-T) intervention was designed to help foster parents behave in ways that promote the development of young children's emerging self-regulatory capabilities. Participants included 173 parent-toddler dyads in three groups: foster families that were randomly assigned to receive either the ABC-T intervention (n = 63) or a control intervention (n = 58), as well as low-risk parent-toddler dyads from intact families (n = 52). At a follow-up conducted when children were approximately 48 months old, children's executive functioning abilities were assessed with the attention problems scale of the Child Behavior Checklist (Achenbach & Rescorla, 2000) and a graded version of the Dimensional Change Card Sort developed for preschoolers (Beck, Schaefer, Pang, & Carlson, 2011). Results showed that foster children whose parents received the ABC-T intervention and low-risk children never placed in foster care had fewer parent-reported attention problems and demonstrated greater cognitive flexibility during the Dimensional Change Card Sort than foster children whose parents received the control intervention. These results indicate that an attachment-based intervention implemented among toddlers in foster care is effective in enhancing children's executive functioning capabilities.

Transactional Patterns of Maternal Depressive Symptoms and Mother-Child Mutual Negativity in an Adoption Sample.

Transactional models of analysis can examine both moment-to-moment interactions within a dyad and dyadic patterns of influence across time. This study used data from a prospective adoption study to test a transactional model of parental depressive symptoms and mutual negativity between mother and child over time, utilizing contingency analysis of second-by-second behavioral data. To consider both genetic and environmental influences on mutual negativity, depressive symptoms were examined in both adoptive and birth mothers. Adoptive mother depressive symptoms at 9 months increased the likelihood that, at 18 months, children reacted negatively to their mothers' negative behavior, which in turn predicted higher levels of adoptive mother depressive symptoms at 27 months, suggesting that over time, mothers' depressive symptoms influence and are influenced by moment-to-moment mutual negativity with their toddlers. Birth mother depressive symptoms moderated the association between mutual negativity at 18 months and adoptive mother depressive symptoms at 27 months, suggesting a child-driven contribution to maternal depressive symptoms that can be measured by a genetic sensitivity.

"I Want to be There When He Graduates:" Foster Parents Show Higher Levels of Commitment than Group Care Providers.

Group care is a frequent placement for adolescents placed in out of home care when their birth parents' care is deemed unsafe. In the present study, we assessed whether foster parents show greater commitment to children than group care providers. Given that group care represents a number of living arrangements, we considered both shift care (where staff work shifts and do not live with the children) and cottage care (where staff live for extended periods of time with the children in a group living context). Commitment was assessed using the This Is My Child Interview (adapted for adolescents). Thirty-one foster parents, 18 shift workers, and 28 cottage care providers were interviewed. As predicted, foster parents showed higher levels of commitment than both shift care workers and cottage care providers, and the associations held when children's externalizing behaviors and the number of children the caregivers had cared for were controlled. The results suggest that foster care promotes greater commitment among caregivers than other out of home placements, and add to other findings that favor foster care as the out of home placement of choice for adolescents.

Longitudinal relations among language skills, anger expression, and regulatory strategies in early childhood.

Researchers have suggested that as children's language skill develops in early childhood, it comes to help children regulate their emotions (Cole, Armstrong, & Pemberton, 2010; Kopp, 1989), but the pathways by which this occurs have not been studied empirically. In a longitudinal study of 120 children from 18 to 48 months of age, associations among child language skill, observed anger expression, and regulatory strategies during a delay task were examined. Toddlers with better language skill, and whose language skill increased more over time, appeared less angry at 48 months and their anger declined more over time. Two regulatory strategies, support seeking and distraction, explained a portion of the variance in the association between language skill and anger expression after toddlerhood.