Frequently Asked Questions

The ABC Manual

What are we trying to gain in each activity?

Activities are included for dedicated practice of ABC targets. With pop-out books, blocks, pudding, stickers, and lotion activities, we are trying to encourage following the lead.  With the puppet activity, we are helping parents override their urge to be intrusive and frightening.  The puppet activity tends to bring out these behaviors in even very sensitive caregivers, providing coaches with opportunities to comment. During these activities we expect coaches to have a higher rate of commenting (about 2 comments a minute, often more), because there is no expectation to be covering other content during the play as well. The coach’s goal is to help the parent be a success during the activity. Comment frequently and descriptively when the coach is succeeding, and scaffold when the parent needs help.

What are some strategies for working with multiple caregivers?

Working with multiple caregivers or multiple children in the home can be overwhelming, but it is helpful for the caregiver to learn ABC in his or her natural home setting, which often includes other children and caregivers.  If a second caregiver is present, encourage him or her to join in the activities and conversation.  Commenting on both of the caregivers behaviors will keep them engaged, help each feel successful, and perhaps help them learn from each other.  Encourage the second caregiver to join activities, and make sure you have enough supplies for them as well, for example having an extra spoon for the pudding activity. You may feel challenged by needing to comment on multiple parent behaviors, but one benefit is that you will never feel that it is too quiet, or that you do not have opportunities for comments! As you become more comfortable in multiple caregiver situations, also try and think about the balance of comments you are giving to each. For instance, are you positively commenting on one but mainly scaffolding the other? If so, try to find opportunities to scaffold the first parent and make a positive comment on the second.

Does ABC work with babies with medical conditions or developmental delays? What’s different?

We have not specifically tested whether or not ABC is effective in these populations, but we have anecdotally seen success at dissemination sites and in some University of Delaware cases. The child should be developmentally between 6 months and 2 years. For instance, do not do the intervention with a child who is 6 months of age, but developmentally only 3. One of our ITM supervisors noted that she has found caregivers to be more teachy or overprotective when they have babies with medical conditions or developmental delays, making the skills of appropriate following the lead and nurturance important and relevant.

What do I do for session 7 if a parent is really good at all of the targets?

There is always something to work on! Even if the coach is generally skilled at all ABC targets try to help the caregiver determine when the targets are the most challenging. Perhaps the caregiver is less likely to nurture when she is overwhelmed or stressed. What makes that challenging and how can she override the automatic response to avoid nurturing/ignore/etc.?

What do I do for Session 7 if a parent struggles with multiple targets?

It is not uncommon for caregivers to have challenges with nurturance, following the lead, delight, and frightening behaviors. If this is the case, prior to Session 7 you should be working hard to prioritize which targets are the most concerning and to directly address those in Sessions 7 and 8. You might not be able to come up with a “voice” for each challenging target, and that’s ok.

Nurturance

Should parents run to get their baby if they cry in their sleep?

Caregivers sometimes ask whether the concepts that we focus on with nurturance apply to sleep training. If the baby cries at 2am, should a parent immediately respond by picking the baby up? We do not cover sleep with ABC because this is a somewhat different issue than what we are trying to do with ABC. If a parent waits 5 minutes before picking up a baby at 5am, it could be due to trying to get the baby to sleep through the night, rather than problems handling negative emotion, dismissing or ignoring, distracting, trying to make the child be tough, etc. If the parent does ask, just let them know that we don’t specifically talk about sleep in this program, but they can use what they take away from ABC in combination with what they feel is right for helping their child (and maybe what they hear from their pediatrician) to make nighttime decisions.

Why shouldn’t parents say “you’re okay”?

Saying “you’re okay” is not nurturing because it doesn’t give the child the message that “I’m here for you no matter what”.  Saying “you’re okay” is dismissing the child’s distress and teaches the child “this shouldn’t make you sad and you can’t come to me if you aren’t hurt.”

If a child screams for no apparent reason, should we encourage parents to nurture?

Yes! The content from sessions 1 and 2 teaches that children might not always give clear cues for nurturance and that caregivers should respond if the child communicates that he or she needs you, or if you judge it to be a situation where he or she needs you but is not signaling clearly. If it sounds like a distressing scream, nurturance should be encouraged. Any time the child is distressed, or is in a distress-eliciting situation, is an opportunity for nurturance.

Following the Lead

What are some signals to look for when following the lead of an infant versus a toddler?

Please see the Following the Lead with Infants document on the Parent Coach section of the website.

Is it okay for a parent to correct a child when following the lead?

We want the parent to go along with what the child is doing, and not to try and correct. Remember the example from training where the child held up a frog and said, “Dinosaur”. The parent said, “Dinosaur?!”, and the coach replied, “That can be a dinosaur! Nice following his lead.” The parent could even say something like, “That looks like a dinosaur, doesn’t it?” The goal is to encourage the parent to follow, not to have the child learn colors/animals/numbers, etc.

Frightening behavior and Overstimulation

How do I address children who initiate rough housing and overstimulating play?

This happens a lot! If you notice it in the first few sessions, just take note, add it to your conceptualization and plan to address it in sessions 5 and 6. Once the parent is familiar and comfortable with the idea that intrusive and frightening behaviors can dysregulate children, you can point out that their job is extra hard since their child seems to be asking for it. You can then talk about how this is one of those times you are actually going to encourage the parent NOT to follow her child’s lead, since you know it could lead to the child being dysregulated or frightened. Praise the parent for all the great following that she has been doing and help her look for other ways to interact with or follow her child’s lead in those moments when he wants to rough house.

Is predatory play a form of frightening behavior?

It can be, especially for kids who have experienced abuse. We often hear, “I’m going to get you!”, and it can be followed by a squeal of excitement from the child, but that can quickly turn to fear/overstimulation/confusion. Encourage parents to discontinue this kind of play for young children, especially if they have been exposed to violence.

What if a parent displays frightening behavior when setting sudden safety limits?

If a child runs into the street and the usually calm parent screams, “No! Get back here, now!”, we would not address the understandable use of yelling to keep the child safe. It’s possible that a child could be frightened after a parent yells or pulls or a child away from a dangerous situation, so make sure the parent sees her important role to nurture the child. If the child is upset or scared it is not the time to lecture about the danger, but the time to nurture and help the child feel safe.

How do I address harsh punishments and timeouts?

We do not explicitly address these in the infant intervention and are working on this in the toddler intervention that we are testing now (won’t be available for a few years). If the punishments are frightening then they can be addressed in Session 6. Timeouts often occur during times when very young children are actually in need of nurturance, so you can help the parent see the need for nurturance instead, without talking about the pros/cons of timeout directly.

Why is tickling so bad?

Tickling is most often a parent-directed activity, similar to pinching cheeks and tossing in the air. It is almost always well-intentioned, with the desire to make the child laugh. However, many people remember laughing because of tickling when a young child but wishing that it would stop. Children give mixed and confusing signals when being tickled, sometimes masking a desire for the behavior to stop and/or fear (particularly if the child has a history of abuse). We encourage parents to find other ways to delight in and interact with their child that is following the child’s lead without dysregulating him or her.

ITM coding and Supervision

What can I do when a parent goes quickly between following the lead and NOT following the lead?

When caregivers switch quickly between following and not following, it can be difficult and confusing to make on-target comments.  Coaches are often concerned that they have missed their opportunity to comment once the following behavior is “spoiled” by a non-following behavior. The best way to comment is to be very clear in describing the behavior that you are praising. For example, if the child hands a block to the caregiver and the caregiver takes and says thank you (following), but then asks the child what color the block is repeatedly (not following), a good on-target comment would be “That’s so great how she held out the block to you and you took it!” The clear description makes it obvious that you are praising the former behavior, not the latter.

If you are in a later session (4-10) and want to also address the teaching behavior, simply add “and it doesn’t even matter if she knows what color it is! You just play right along with her.”

Technology

Uploading videos to send to my supervisors takes hours! Is this normal?

Yes! Depending on how fast your internet is, the upload/download time can be long. If you seem to have slow internet, you can start uploading late in the evening and check that it was sent successfully the next morning.