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 who enter foster care have usually experienced maltreatment as well as disruptions in relationships with primary caregivers. These children are at risk for a host of problematic outcomes. However, there are few evidence-based interventions that target foster children. This article presents preliminary data testing the effectiveness of an intervention, Attachment and Biobehavioral Catch-up, to target relationship formation in young children in the foster care system. Children were randomly assigned to the experimental intervention that was designed to enhance regulatory capabilities or to a control intervention. In both conditions, the foster parents received in-home training for 10 weekly sessions. Post-intervention measures were collected 1 month following the completion of the training. Outcome measures included children's diurnal production of cortisol (a stress hormone), and parent report of children's problem behaviors. Children in the experimental intervention group had lower cortisol values than children in the control intervention. Also, the experimental intervention parents reported fewer behavior problems

The concordance between foster mothers' attachment state of mind and foster infants' attachment quality was examined for 50 foster mother-infant dyads. Babies had been placed into the care of their foster mothers between birth and 20 months of age. Attachment quality was assessed between 12 and 24 months of age, at least 3 months after the infants' placement into foster care. The two-way correspondence between maternal state of mind and infant attachment quality was 72%, kappa = .43, similar to the level seen among biologically intact mother-infant dyads. Contrary to expectations, age at placement was not related to attachment quality. Rather, concordance between maternal state of mind and infant attachment was seen for relatively late-placed babies, as well as early placed babies. These findings have two major implications. First, following a disruption in care during the first year and a half of life, babies appear capable of organizing their behavior around the availability of new caregivers. Second, these data argue for a nongenetic mechanism for the intergenerational transmission of attachment.

Individual differences in attachment organization among adults with serious psychopathological disorders were related to strategies of treatment use. Forty young adults with serious psychopathological disorders were administered the Adult Attachment Interview (George, Kaplan, & Main, 1984), and their clinicians completed ratings of treatment use. Attachment organization was assessed using the Attachment Q-set (Kobak, 1989), yielding ratings of security/anxiety and avoidance/preoccupation. In preliminary analyses, diagnosis was found to be related to security, with greater security associated with affective rather than thought disorders. Gender was related to avoidance/preoccupation, with males having stronger avoidant tendencies than females. The effects of diagnosis and gender were partialled out of subsequent analyses. As predicted, greater security was associated with more compliance with treatment, as rated by clinicians. Stronger avoidant tendencies were associated with greater rejection of treatment providers, less self-disclosure, and poorer use of treatment. These findings suggest that attachment organization may be an important determinant of how individuals with serious psychopathological disorders approach attachment figures.

By asking the subject to consider a host of potentially threatening attachment-related issues, the Adult Attachment Interview (AAI) allows an assessment of different strategies for regulating the attachment system. These strategies can be assessed along the 2 dimensions of security/anxiety and deactivation/hyperactivation. The greatest inferential leaps may be in characterizing strategies as deactivating. For example, individuals using deactivating strategies often report extremely positive relationships with parents, display restricted recall of attachment memories, and play down the significance of early attachment experiences. If these descriptive features are guided by a strategy that requires diverting attention from attachment information, subjects employing this strategy should experience conflict or inhibition during the Attachment Interview. In the present study, skin conductance levels were monitored for 50 college students during a baseline period and throughout the Attachment Interview. Subjects employing deactivating strategies showed marked increases in skin conductance levels from baseline to questions asking them to recall experiences of separation, rejection, and threat from parents. This finding supports the notion that individuals employing deactivating attachment strategies experience conflict or inhibition during the Attachment Interview.

Studies with nonhuman primates and rodents, as well as with human children, have suggested that early separations from caregivers are often associated with changes in the functioning of the hypothalamus-pituitary-adrenal (HPA) axis. On the basis of these findings, we designed a relational intervention that was intended to normalize HPA functioning among children in foster care. This paper presents findings from a randomized clinical trial that assessed the effectiveness of a relational intervention (Attachment and Biobehavioral Catch-up [ABC]) with regard to HPA functioning. The ABC intervention was intended to enhance children's ability to regulate physiology and behavior. The control intervention (Developmental Education for Families) was intended to enhance children's cognitive skills. A comparison group of children who had never been in foster care was also included. Children's cortisol production was assessed upon arrival at the lab, and 15 and 30 min following the Strange Situation. Random effects analyses of variance were performed to assess differences in initial values and change between children in the two intervention groups. Children in the ABC intervention and comparison group children showed lower initial values of cortisol than children in the treatment control group, considering arrival at lab as initial values (p < .05). Groups did not differ significantly in change over time. These results suggest that the ABC intervention is effective in helping children regulate biology in ways more characteristic of children who have not experienced early adversity.

Early-life stress (ES) has been associated with diverse forms of psychopathology. Some investigators suggest that these associations reflect the effects of stress on the neural circuits that support cognitive control. However, very few prior studies have examined the associations between ES, cognitive control, and underlying neural architecture. The present study compares adolescents with a documented history of ES to typical adolescents on a cognitive control task using functional magnetic resonance imaging (fMRI). Twelve ES adolescents who were adopted because of early caregiver deprivation (9 females, age = 13 years ± 2.58) and 21 healthy control adolescents without a history of ES (10 females, age = 13 years ± 1.96) who resided with their biological parents performed the change task (Nelson et al., 2007) -a variant of the stop taskduring fMRI. Behaviourally, ES adolescents took longer to switch from a prepotent response ("go") to an alternative response ("change") than control adolescents. During correct "change" responses vs. correct "go" responses, this behavioural group difference was accompanied by higher activation in ES subjects than controls. These differences were noted in regions involved in primary sensorimotor processes (pre-and postcentral gyri), conflict monitoring (dorsal anterior cingulate gyrus), inhibitory and response control (inferior prefrontal cortex and striatum), and somatic representations (posterior insula). Furthermore, correct "change" responses vs. incorrect "change" responses recruited the inferior prefrontal cortex (BA 44/46) more strongly in ES subjects than controls. These data suggest impaired cognitive control in youth who experienced ES.

Young children in foster care have often experienced inadequate early care and separations from caregivers. Preclinical studies suggest that early inadequate care and separations are associated with long-term changes in regulation of the hypothalamic-pituitary-adrenal (HPA) axis. In this study, the daytime pattern of cortisol production was examined among 55 young children who had been placed into foster care and 104 children who had not. Saliva samples were taken at wake-up, in the afternoon, and bedtime for 2 days. Average salivary cortisol values for each time of day were computed. A group (foster vs. comparison) time (morning, afternoon, night) interaction emerged, reflecting less decline in levels across the day for foster than comparison children. Daytime patterns were categorized as typical, low, or high. Children who had been in foster care had higher incidences of atypical patterns of cortisol production than children who had not. These differences suggest that conditions associated with foster care interfere with children's ability to regulate neuroendocrine functioning.