Young children who have experienced early adversity are at risk for developing disorganized attachments. An intervention, Attachment and Biobehavioral Catch-up (ABC), was developed that very specifically targets nurturing, sensitive care among the parents identified as being at risk for neglecting their young children, with the aim of decreasing disorganized attachment. The ABC intervention consists of 10 parent-child sessions conducted in families’ homes. The present study assessed the efficacy of this intervention through a randomized clinical trial in which parents with Child Protective Services involvement were assigned to the experimental intervention or to a control intervention (DEF). Attachment quality was assessed for 120 children in the Strange Situation. Children in the ABC intervention showed significantly lower rates of disorganized attachment (32%) and higher rates of secure attachment (52%) relative to the control intervention (57% and 33%, respectively). These results support the efficacy of the ABC intervention in enhancing attachment quality among parents at high risk for maltreatment.

Children exposed to various forms of adversity early in life are at increased risk for a broad range of developmental difficulties, affecting both cognitive and emotional adjustment. We review a growing body of evidence suggesting that exposure to adverse circumstances affects the developing brain in ways that increase risk for a myriad of problems. We focus on two forms of adversity, one in which children are exposed to childhood maltreatment in family environments, and another in which children are exposed to extreme psychosocial deprivation in contexts of institutional rearing. We discuss ways in which each of these experiences represent violations of species-expected caregiving conditions, thereby imposing challenges to the developing brain. We also review emerging data pointing to the effectiveness of early intervention in remediating neurodevelopmental consequences associated with maltreatment or institutional rearing. We conclude by discussing implications of this work for public health efforts and highlight important directions for the field.

Although epidemiological data provide evidence that early life experience plays a critical role in human development, the mechanism of how this works remains in question. Recent data from human and animal literature suggest that epigenetic changes, such as DNA methylation, are not only involved in cellular differentiation, but also in the modulation of genome function in response to early life experience affecting gene function and the phenotype. Such modulations may serve as a mechanism for life-long genome adaptation. These changes seem to be widely distributed across the genome and to involve central and peripheral systems. Examining the environmental circumstances associated with the onset and reversal of DNA methylation will be critical for understanding risk and resiliency.

Young children who enter foster care experience disruptions in care and maltreatment at a point when maintaining attachment relationships is a key, biologically based task. In previous research, we have found that young children experience challenges as they form attachments with new caregivers. They tend to push their new caregivers away, even though such children are especially in need of nurturing care. Further, many caregivers do not respond in nurturing ways when their children are distressed, which we have found is problematic for young children in foster care. We developed an intervention that is designed to help caregivers provide nurturance even when children do not elicit it, and even when it does not come naturally to them. This paper presents preliminary findings of the effectiveness of this intervention on children’s attachment behaviors. Forty-six children were randomly assigned to either the experimental intervention or to an educational intervention. For three consecutive days, attachment behaviors were reported across three distress-eliciting situations. Children whose parents had received the experimental intervention showed significantly less avoidance than children whose parents had received the educational intervention. These preliminary results suggest that the intervention is successful in helping children develop trusting relationships with new caregivers.

Importance Severe early life neglect is associated with compromises in brain development and associated behavioral functioning. Although early intervention has been shown to support more normative trajectories of brain development, specific improvements in white matter pathways that underlie emotional and cognitive development are unknown. Objective To examine associations between early life neglect, early intervention, and microstructural integrity of white matter pathways in middle childhood. Design, setting, and participants The Bucharest Early Intervention Project is a randomized clinical trial of high quality foster care as an intervention for institutionally reared children in Bucharest, Romania. During infancy, children were randomly selected to remain in an institution or to be placed into foster care. Developmental trajectories of these children were compared to a group of socio-demographically matched children reared in biological families at baseline and several points throughout development. At around eight years of age, 69 of the original 136 children underwent structural MRI scans. Intervention(s) for Clinical Trials Institutionally reared children were randomized into high quality foster homes in Bucharest, Romania. Main Outcome Measure(s) Four estimates of white matter integrity (Fractional Anisotropy, and Mean, Radial, and Axial Diffusivity) for 48 white matter tracts throughout the brain were obtained through Diffusion Tensor Imaging. Results Significant associations emerged between early life neglect and microstructural integrity of the body of the corpus callosum and tracts involved in limbic circuitry (fornix crus, cingulum), fronto-striatal circuitry (anterior and superior corona radiata, external capsule) and sensory processing (medial lemniscus, retrolenticular internal capsule). Follow up analyses revealed that early intervention promoted more normative white matter development among previously neglected children who entered foster care. Conclusions and Relevance Results suggest that removal from conditions of severe early life neglect and entry into a high quality family environment can support more normative trajectories of white matter growth. Findings have implications for public health and policy efforts designed to promote normative brain development among vulnerable children. Trial Registration clinicaltrials.gov Identifier: NCT00747396

The hypothalamus-pituitary-adrenal (HPA) axis is particularly sensitive to conditions of maltreatment. In particular, neglected children have shown a flatter slope with lower wake-up values relative to non-neglected children. An intervention, Attachment and Biobehavioral Catch-up (ABC), was developed to enhance biological and behavioral regulation in young children at risk for neglect. The effectiveness of the intervention was assessed in a randomized clinical trial for children with involvement with Child Protective Services. Following the interventions, children receiving the ABC intervention (n = 49) showed more typical cortisol production, with higher wake-up cortisol values and a steeper diurnal slope than children receiving the control intervention (n = 51). These results suggest that the ABC intervention is effective in enhancing biological regulation.

Infants in foster care need sensitive, responsive caregivers to promote their healthy outcomes. The current study examined the effectiveness of the Attachment and Biobehavioral Catch-up Intervention, a short-term, targeted, attachment-based intervention program designed to promote sensitive caregiving behavior among foster mothers. Ninety-six foster mother–infant dyads participated in this study; 44 dyads were assigned to the Attachment and Biobehavioral Catch-up Intervention, and 52 dyads were assigned to a control intervention. Results of hierarchical linear modeling indicated that foster mothers who were assigned to the Attachment and Biobehavioral Catch-up Intervention showed greater improvements in their sensitivity from pre- to postintervention assessment time points when compared with foster mothers who were assigned to the control intervention. We conclude that a short-term, targeted, attachment-based intervention is effective in changing foster mothers’ responsiveness to their foster infants, which is critical for foster infants’ healthy socioemotional adjustment.

In recent years, translational research involving humans and animals has uncovered biological and physiological pathways that explain associations between early adverse circumstances and long-term mental and physical health outcomes. In this article, we summarize the human and animal literature demonstrating that epigenetic alterations in key biological systems, the hypothalamus–pituitary–adrenal axis and immune system, may underlie such disparities. We review evidence suggesting that changes in DNA methylation profiles of the genome may be responsible for the alterations in hypothalamus–pituitary–adrenal axis and immune system trajectories. Using some preliminary data, we demonstrate how explorations of genome-wide and candidate-gene DNA methylation profiles may inform hypotheses and guide future research efforts in these areas. We conclude our article by discussing the many important future directions, merging perspectives from developmental psychology, molecular genetics, neuroendocrinology, and immunology, that are essential for furthering our understanding of how early adverse circumstances may shape developmental trajectories, particularly in the areas of stress reactivity and physical or mental health.