ABC Intervention | Research
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Research Supporting ABC

We have found evidence supporting the efficacy of ABC in three independent samples, suggesting that ABC is effective in improving attachment and helping regulate both biology and behavior in at-risk children. We, and others, have also found early evidence supporting the efficacy of ABC at dissemination sites across the country.

Infants of at-risk birth parents (under age 2 at enrollment):


Families were referred by agencies working with child protective services. All parents were enrolled in the city’s program that was intended to divert children from foster care because of identified needs and ⁄or concerns that children were at risk. Domestic violence, parental substance use, homelessness, and child neglect were the conditions noted most often. Families were randomly assigned to receive the ABC intervention or a control intervention.



More of the children whose parents received the ABC intervention were classified as having secure attachments than those in the control group (52% of children receiving ABC vs. 33% of children receiving a control intervention). In addition, fewer of the children in the ABC intervention group had disorganized attachments than those in the control group (only 32% of ABC children were classified as disorganized vs. 57% of children in the control group)  (Bernard, Dozier, Bick, Lewis-Morrarty, Lindhiem, & Carlson, 2012).


Cortisol production

Children who received the ABC intervention had a more normative diurnal pattern of cortisol production (steeper slopes and higher wake-up values of cortisol) than children who received the control intervention (Bernard, Dozier, Bick, & Gordon, 2015).


When assessed three years after completing the ABC intervention, children who received the ABC intervention continued to have a more normative diurnal cortisol pattern than the children who had received the control intervention (Bernard, Hostinar, & Dozier, 2015).


Emotion expression

During a challenging task designed to elicit frustration, children who received the ABC intervention displayed less overall anger, and less anger towards their parents in particular, than children who received the control intervention (Lind, Bernard, Ross, & Dozier, 2014).

Infants in foster care (under age 2 at enrollment):


Families were foster parents and children in their care. Families were randomly assigned to receive the ABC intervention or a control intervention.


Maternal sensitivity

Sensitivity, or when a caregiver is able to notice, understand, and respond appropriately to a child’s cues, is especially important for children who have experienced early adversity. Foster parents who received the ABC intervention demonstrated a bigger improvement in sensitivity (measured before and after receiving the 10-week ABC intervention) than foster parents who received the control intervention (Bick & Dozier, 2013).​



Theory of mind (being able to understand that other people have different perspectives, emotions, and motivations) and executive functioning (cognitive processes that help regulate behavior and emotions) are both important developmental skills. Between 4 and 6 years of age (2-4 years after the intervention), foster children who received the ABC intervention had stronger executive functioning and theory of mind skills than foster children in the control group. In addition, when looking at these skills, the foster children who had received ABC did not differ significantly from the comparison group of children who had never been involved with the foster care system (Lewis-Morrarty, Dozier, Bernard, Terraciano, & Moore, 2012).

Toddlers in foster care (between ages 2 and 4 at enrollment):


Families were foster parents and toddlers in their care. Families were randomly assigned to receive the ABC-Toddler intervention or a control intervention.



Foster children whose parents received the ABC-T intervention had fewer attention problems and better executive functioning capabilities than foster children whose parents received the control intervention (Lind, Raby, Caron, Roben, & Dozier, 2017).

Effects of ABC Dissemination:


   Parents seen by community-based clinicians in Hawaii showed improvements from pre-to post-intervention in sensitivity, delight, and intrusiveness (Caron, Weston-Lee, Haggerty & Dozier, 2016). Frequency and quality of the hypothesized active ingredient of ABC, in the moment comments, predicted parent behavior change, as well as likelihood of early dropout, in this sample (Caron, Bernard & Dozier, 2016).

   Large effect sizes for parent behavior change have also been found in a larger sample of 108 parents seen by 37 parent coaches in 5 dissemination sites (Roben, Dozier, Caron & Bernard, 2017).


   In a small community-based randomized clinical trial, families who participated in ABC had lower scores on child abuse potential, parenting stress, and child internalizing and externalizing behaviors than families who were in a wait-list control condition (Sprang, 2009).


   In a second small community-based RCT testing for intervention effectiveness for new mothers receiving residential substance abuse treatment, mothers who participated in ABC demonstrated more sensitive parenting behaviors than mothers in the control group (Berlin, Shanahan, & Appleyard Carmody, 2014).

Research Projects

High-Risk Birth Parents

Children from families who are involved with Child Protective Services are at greater risk developing problems related to their socio-emotional, cognitive, and brain development.  Early research with these families who received ABC demonstrated positive effects for attachment security, emotion expression, and physiological regulation among young children.


We have continued to follow these children across childhood and will be testing the long-term effects of the early programs for children’s development during middle childhood. Children will be assessed when they are 8, 9, and 10 years old because this is an age-range when regulatory capabilities have typically consolidated, and demands for self-regulation are high. Specific measures will focus on children’s inhibitory control, emotion regulation, peer relations, and physiological regulation as assessed through measurement of the hormone cortisol.




Funding: National Institute of Mental Health R01 MH074374 award, “Intervening Early with Neglected Children: Key Middle Childhood Outcomes.” Period of support: May 1, 2014-March 31, 2019.

Toddlers in Foster Care

Toddlers who are in foster care often exhibit a variety of behavioral, emotional, and physiological problems. Some of the significant challenges they face include forming new attachment relationships and developing the ability to regulate their behavior and their physiological responses to stress. Because of the unique needs and experiences of this group of children, caregivers often find it difficult to ensure that children are provided with the nurturance and care they need in order to develop secure relationships while also providing children with the appropriate amount of behavioral supports so that they can learn to regulate their behavior.


Caregivers and toddlers who enrolled in this study were randomly assigned to one of the two, 10-session programs: the Attachment and Biobehavioral Catch-Up for Toddlers (ABC-T) program, or the Developmental Education for Families (DEF) program that was developed to improve motor and language outcomes for children.



Funding: National Institute of Mental Health R01 MH052135 award, “Specialized mental health services for toddlers in foster care.” Period of support: January 1, 2009-December 31, 2014.

Children Adopted Internationally

The number of children adopted internationally has increased dramatically over the last two decades. Children adopted from other countries may experience a variety of deficits in their pre-adoptive living situations including a lack of nutritious food, limited sensory experiences and inadequate support from and interaction with caregivers. As a result, some children experience a range of problems including inattention, deficits in inhibitory control, emotional difficulties, motor problems, and physical health problems. Although rapid gains are seen in some areas, other problems may persist in some children. Thus, it is critical that interventions be developed that address the specific issues faced by these children and their parents.


In 2009, the National Institute of Mental Health awarded Dr. Dozier a grant to study the short- and long-term efficacy of the ABC and DEF interventions.




Funding: National Institute of Mental Health R01 MH084135 award, “Services for Children Adopted Internationally.” Period of support: January 1 2009- December 31, 2014.

Fostering Relationships

After foster care placement, birth parents are often limited to supervised visitation at an office or “visitation center”. Foster parents, now the child’s primary caregiver, are only sporadically present at these visits. Such visits can go poorly; children and parents are often upset, as both birth and foster parents can have unrealistic expectations and children may feel confusion and anxiety about separation from their caregiver. We are studying an adaptation of ABC to be used as a method for improving visitation visits between children, foster parents, and birth parents. This program is called Fostering Relationships. The goals of Fostering Relationships are to:

1) Strengthen the relationship between foster parents and birth parents

2) Help birth parents to have a successful visit, feel less rejected by their child, and so encourage repeated visitation, and

3) Increase foster and birth parent use of sensitive parenting behaviors.