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.

Using an intensive short-term longitudinal design, this study first examined whether there were significant differences in maternal sensitivity and intrusiveness after completion of Attachment and Biobehavioral Catch-up (ABC; Dozier & the Infant-Caregiver Project Lab, 2013) when compared to a control condition. The second aim was to explore the rate and shape of change in parenting behaviors. Participants were 24 mothers and their biological children, who were randomly assigned to ABC (n = 13) or a control condition (n = 11). A structured play assessment with each mother and her child was video-recorded prior to randomization into the study, before each intervention session, and at a follow-up visit. A total of 270 videos were coded for sensitivity and intrusiveness. Hierarchical linear growth models were used to estimate the total change in parenting qualities across the 10 intervention sessions when comparing ABC to a control condition. Piecewise hierarchical linear growth models were used to investigate patterns of change across the intervention for mothers within ABC. Mothers in the ABC condition showed greater increases in sensitivity and decreases in intrusiveness than mothers in the control condition. There was evidence for nonlinear patterns of change in sensitivity and intrusiveness among mothers in ABC. These results support the effectiveness of ABC in changing sensitivity quickly.

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The functioning of the hypothalamic pituitary adrenal (HPA) axis can be altered by adverse early experiences. Recent studies indicate that children who were adopted internationally after experiencing early institutional rearing and unstable caregiving exhibit blunted HPA reactivity to stressful situations. The present study examined whether caregiving experiences post-adoption further modulate children's HPA responses to stress. Parental sensitivity during naturalistic parent-child play interactions was assessed for 66 children (M age = 17.3 months, SD = 4.6) within a year of being adopted internationally. Approximately 8 months later, children's salivary cortisol levels were measured immediately before as well as 15 and 30 min after a series of brief separations from the mother in an unfamiliar laboratory setting. Latent growth curve modeling indicated that experiencing more parental sensitivity predicted increased cortisol reactivity to the stressor. Although half the families received an intervention designed to improve parental sensitivity, the intervention did not significantly alter children's cortisol outcomes. These findings suggest that post-adoption parental sensitivity may help normalize the HPA response to stress among children adopted internationally.

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.