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Cited by 430Attachment and Relationship DynamicsChild Abuse and TraumaChild Welfare and Adoption

Enhancing Attachment Organization Among Maltreated Children: Results of a Randomized Clinical Trial

Open access
Bernard, Kristin, Dozier, Mary, Bick, Johanna, Lewis-Morrarty, Erin, Lindhiem, Oliver, Carlson, Elizabeth·2012·Child Development
DOI 10.1111/j.1467-8624.2011.01712.xPMC PMC3305815
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Abstract

Young children who have experienced early adversity are at risk for developing disorganized attachments. The efficacy of Attachment and Biobehavioral Catch-up (ABC), an intervention targeting nurturing care among parents identified as being at risk for neglecting their young children, was evaluated through a randomized clinical trial. Attachment quality was assessed in the Strange Situation for 120 children between 11.7 and 31.9 months of age (M = 19.1, SD = 5.5). 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.

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Crossref · 10.1111/j.1467-8624.2011.01712.x

Cites

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Claims the paper makes

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  • Findingown data

    In the randomized trial, children in the ABC group had a significantly higher rate of secure attachment (52%) than children in the DEF control group (33%).

    “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).”
    Quote in the paperSubstantial claim
  • Findingown data

    Analyses restricted to children between 12 and 24 months found that the results held with that smaller sample.

    “However, we conducted analyses with children who are between the ages of 12 and 24 months and found that our results held with that smaller sample.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The DEF control intervention does not affect children's attachment outcomes.
  • Findingown data

    In the randomized trial, children in the ABC group had a significantly lower rate of disorganized attachment (32%) than children in the DEF control group (57%).

    “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).”
    Quote in the paperSubstantial claim
  • Findingnone given

    All mothers in the study had been previously identified as at risk of maltreating their children.

    “Second, all of the mothers in the current study had been previously identified as being at-risk of maltreating their children.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Disorganized attachment measured at 18 months predicts dissociative symptoms later in middle school, high school, and early adulthood.

    “Carlson found that disorganized attachment at 18 months of age predicted dissociative symptoms during middle school, high school, and early adulthood, based on teacher-report, self-report, and clinical interviews.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Carlson, 1998 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 24
  • The quote only partly states this claim. 4
  • May combine two claims. 25

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    At the Strange Situation, children were between 11.7 and 31.9 months of age (M=19.1, SD=5.5).

    “At the time children participated in the Strange Situation, they were between the ages of 11.7 and 31.9 months of age (M = 19.1, SD = 5.5).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Children in the ABC intervention group had lower rates of disorganized attachment than children in the DEF control group (32% vs 57%; χ2(1,120)=7.60, p<.01; d=.52).

    “Relative to children in the control intervention group, children in the ABC intervention group showed lower rates of disorganized attachments, χ2 (1,120) = 7.60, p < .01.”
    • Also stated in: § Primary results · plain
      “As can be seen in Table 2, 32% of the ABC children had disorganized attachments, whereas 57% of the DEF children had disorganized attachments.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The DEF control intervention does not affect children's attachment outcomes.
    • Rests on an assumption: Strange Situation classifications are valid for children older than 24 months.

  • May combine two claims.

    Findingown data

    When children older than 24 months were excluded, the ABC-DEF difference in disorganized attachment remained significant (χ2(1,95)=5.06, p<.05; d=.47), but the difference in secure attachment did not (χ2(1,95)=1.85, p>.05; d=.28).

    “These results remained significant when excluding children who were older than 24 months at the time of the Strange Situation, for attachment disorganization, χ2 (1,95) = 5.06, p < .05 (effect size: d = .47), but not for attachment security, χ2 (1,95) = 1.85, p > .05 (effect size: d = .28).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The DEF control intervention does not affect children's attachment outcomes.

  • The quote only partly states this claim.

    Findingown data

    Children in the ABC intervention group had higher rates of secure attachment than children in the DEF control group (52% vs 33%; χ2(1,120)=4.13, p<.05; d=.38).

    “Similarly, children in the ABC intervention group showed significantly higher rates of secure attachment, relative to children in the DEF intervention group, χ2 (1,120) = 4.13, p < .05.”
    • Also stated in: § Primary results · plain
      “Whereas 52% of children in the ABC intervention group had secure attachments, only 33% of children in the DEF intervention group had secure attachments.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The DEF control intervention does not affect children's attachment outcomes.
    • Rests on an assumption: Strange Situation classifications are valid for children older than 24 months.

  • May combine two claims.

    Premisecitation

    Parental depression, substance use, and inter-parental discord are associated with more child disorganized attachment, but meta-analytic evidence for these links is mixed and weaker than for parental attachment state of mind.

    “More global parental problems, including parental depression, substance use, and inter-parental discord are also associated with increased incidence of child disorganized attachment (Lyons-Ruth et al., 1991; O’Connor, Sigman, & Brill, 1987; Owen & Cox, 1997; Teti, Messinger, Glefland, & Isabella, 1995); however, these findings are mixed and less substantial than associations with attachment state”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Lyons-Ruth et al., 1991 source

      Not checked in the free run.

    • cites O’Connor, Sigman, & Brill, 1987

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    • cites van IJzendoorn et al., 1999 source

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  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In the Lyons-Ruth et al. trial, disorganized attachment occurred in 54% of treated high-risk infants, versus 70% of untreated high-risk infants and 34% of untreated community infants; the effect was small (d = .30).

    “Following treatment, 54% of high-risk infants had disorganized attachments, compared with 70% of the untreated, high-risk infants and 34% of the untreated, community infants. The effect size of this difference in disorganized attachment between high-risk children who received intervention services versus those that did not was small (d = .30) (Bakermans-Kranenburg et al., 2005).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Lyons-Ruth et al. (1990) source

      Not checked in the free run.

    • cites Bakermans-Kranenburg et al., 2005 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Intervention effects on disorganized attachment are larger when infants are older than 6 months and when the primary risk lies in the child rather than the parent.

    “Regarding sample characteristics, effects were larger for interventions for families with infants older than 6 months of age and for families in which the risk resided primarily in the child, rather than the parent.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Bakermans-Kranenburg et al., 2005 source

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    The VIPP and VIPP-R interventions showed no significant differences in attachment security or organization; disorganized rates were 40%, 30%, and 20% for VIPP, VIPP-R, and control, with negative effect sizes (d = −.41 and d = −.21).

    “Attachment quality was evaluated when children were 13 months, but no significant differences were found for attachment security or attachment organization. Percent of children with disorganized attachment was in the unexpected direction, with 40%, 30%, and 20% in the first intervention group (VIPP), second intervention group (VIPP-R), and control group, respectively (VIPP effect size: d = −.41;”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Bakermans-Kranenburg and colleagues (1998)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Heinicke et al. intervention reduced disorganized attachment: 13% of intervention children versus 27% of controls were disorganized (d = .36).

    “Of 31 children in the intervention group assessed in the Strange Situation, 13% were classified as disorganized, whereas 27% of the 22 children in the control group were classified as disorganized (effect size: d = .36).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Heinicke and colleagues (1999)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The ABC intervention was designed to be brief (10 sessions) because a meta-analysis found that attachment-based programs with a small or moderate session count outperformed longer ones (>16 sessions).

    “First, the intervention was designed to be relatively brief, completed in 10 sessions, as suggested by a meta-analysis conducted by Bakermans-Kranenburg, van IJzendoorn, and Juffer (2003), which found that attachment-based interventions with a small to moderate number of sessions were more effective than longer interventions (> 16 sessions).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Bakermans-Kranenburg, van IJzendoorn, and Juffer (2003)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Children with disorganized attachment show biological stress dysregulation, including elevated cortisol or sympathetic reactivity and blunted diurnal cortisol patterns.

    “However, infants with disorganized attachments are not buffered from stress in such ways; rather, they show stress reactive responses in the form of elevated cortisol (Bernard & Dozier, in press; Hertsgaard, Gunnar, Farrell, Erickson, & Nachmias, 1995; Spangler & Grossman, 1993) or sympathetic nervous system reactivity (Oosterman, De Schipper, Fisher, Dozier, & Schuengel, 2010).”
    • Also stated in: § Attachment disorganization · plain
      “Luijk and colleagues (2010) found that children with disorganized attachments did not show heightened cortisol reactivity, but did show more blunted diurnal patterns of cortisol production relative to children with organized attachment.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Bernard & Dozier, in press

      Not checked in the free run.

    • cites Hertsgaard, Gunnar, Farrell, Erickson, & Nachmias, 1995

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    • cites Oosterman, De Schipper, Fisher, Dozier, & Schuengel, 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Manualization is considered important for treatment integrity and effectiveness generally and for interventions targeting disorganized attachment.

    “Treatment manualization is considered an important factor in treatment integrity and treatment effectiveness, both in general (Weisz, Jensen-Doss, & Hawley, 2006) and in interventions targeting disorganized attachment (Bakermans-Kranenburg et al., 2005).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Weisz, Jensen-Doss, & Hawley, 2006 source

      Not checked in the free run.

    • cites Bakermans-Kranenburg et al., 2005 source

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    The STEEP program had no significant effect on attachment security or organization; 41% of intervention children were disorganized versus 19% of controls, an effect in the unexpected direction (d = −.49).

    “There were no significant effects on attachment security or attachment organization. Of the children in the intervention group, 41% were classified as disorganized, compared with 19% in the control group, resulting in an effect in the unexpected direction (d = −.49).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Egeland & Erickson (1993)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Parental insensitivity by itself predicts insecure but organized attachment and is not strongly linked to disorganized attachment.

    “Although parental insensitivity alone is predictive of insecure, but organized, attachment patterns (De Wolff & van IJzendoorn, 1997), insensitivity alone is not strongly associated with disorganized attachment (van IJzendoorn et al., 1999).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites De Wolff & van IJzendoorn, 1997

      Not checked in the free run.

    • cites van IJzendoorn et al., 1999 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Children become disorganized in attachment because they are frightened by the caregiver they turn to for comfort.

    “According to Main and Hesse (1990), children develop disorganized attachments as the result of being frightened of the person to whom they look for reassurance.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Main & Hesse, 1990

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premiseown data

    The Moss et al. intervention reduced disorganized attachment and protected against developing it; at post-test, 20% of intervention children versus 56.3% of controls were disorganized (d = .79).

    “The intervention appeared effective in both reducing rates of disorganized attachment (change from disorganized attachment at pre-test to organized attachment at post-test) and protecting children from developing disorganized attachments (preventing change from organized attachment at pre-test to disorganized attachment at post-test).”
    • Also stated in: § Interventions targeting disorganized attachment · plain
      “At post-test, 20 percent of children in the intervention group were classified as disorganized, compared with 56.3 percent of children in the control group (effect size: d = .79).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Moss and colleagues (in press)

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    Infant-parent psychotherapy and psychoeducational parenting intervention both produced significantly lower disorganized attachment rates at post-intervention than community-standard and normative control groups, with medium to large effects (d = .84-1.13).

    “Both intervention groups (i.e., infant-parent psychotherapy and psychoeducational parenting intervention) showed significantly lower rates of disorganized attachment at post-intervention assessments, compared to community standard (treatment as usual) and normative (non-maltreating) control groups, with medium to large effect sizes (d = .84 – 1.13).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Cicchetti, Rogosch, and Toth (2006) source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Frightening or frightened parental behavior and atypical maternal behaviors such as hostility, intrusiveness, withdrawal, and role confusion are associated with disorganized attachment.

    “Given that frightening parental behavior has been identified as a predictor of disorganized attachment (Schuengel et al, 1999), it seemed particularly important to help parents not engage in behavior that might be threatening.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Main & Hesse, 1990

      Not checked in the free run.

    • cites Schuengel, Bakermans-Kranenburg, & van IJzendoorn, 1999 source

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    • cites Lyons-Ruth, Bronfman, & Parsons, 1999 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Two coders, blind to other study information, classified the Strange Situation videos.

    “Two coders, blind to other study information, classified the videos.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The approach of grouping children classified as disorganized and as cannot classify has been used previously.

    “This approach for grouping children classified as disorganized and children classified as “cannot classify” has been used previously (e.g., Behrens, Hesse, & Main, 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Behrens, Hesse, & Main, 2007

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The primary coder had attended a 2-week course at the University of Minnesota and passed a reliability test with at least 80% agreement with expert coders.

    “The primary coder (Initials omitted for blind review) had attended the 2-week course at the University of Minnesota and passed the reliability test (reaching at least 80% agreement with expert coders).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    After consent, parents were randomly assigned to ABC or to the DEF control intervention.

    “After consenting, parents were randomly assigned to receive either the Attachment and Biobehavioral Catch-up Intervention or a control intervention (Developmental Education for Families: DEF).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The DEF control sessions had the same duration (10 hour-long sessions) and weekly frequency as the ABC intervention.

    “The Developmental Education for Families sessions was of the same duration (10 hour-long sessions) and frequency (weekly) as the Attachment and Biobehavioral Catch-up intervention.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    To check that results were not due to including older children, analyses excluding children older than 24 months were conducted alongside analyses including all children.

    “To ensure that any results were not attributable to our inclusion of older children in this study, we conducted analyses excluding children older than 24 months of age, in addition to analyses that included all children.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The ABC and DEF interventions had the same duration and frequency.

    “The interventions were of the same duration and frequency.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Attachment classifications were unrelated to child and parent demographic variables.

    “Attachment classifications were unrelated to child and parent demographic variables.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The Strange Situation has been validated for children 12 to 18 months old, with some investigations extending its use to 24 months.

    “The Strange Situation has been validated for use with children between 12 and 18 months of age (Ainsworth et al., 1978), with some investigations extending this age to 24 months (e.g., Dozier et al., 2001; Steele, Murphy, & Steele, 2010; see Cyr et al., 2010).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Ainsworth et al., 1978

      Not checked in the free run.

    • cites Dozier et al., 2001 source

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    • cites Cyr et al., 2010 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study lacked access to family records and relied on incomplete referring-agency reports that were subject to differential caseworker reporting habits.

    “However, we did not have access to families’ records, and we were therefore limited to reports of conditions by the referring agency. Additionally, these reports were incomplete and subject to differential caseworker reporting habits.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The intervention's characteristics will support the feasibility of dissemination into the community.

    “Importantly, these characteristics will support the feasibility of dissemination into the community.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Randomized ABC and DEF groups did not differ significantly on child age at enrollment, age at Strange Situation, gender, minority status, parent age, parent education, or parent minority status.

    “Children randomly assigned to the ABC intervention did not differ significantly from children assigned to the DEF intervention with regard to age at enrollment, age at Strange Situation, gender, or minority status. Similarly, there were no group differences in parent age, parent education, or parent minority status.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    New skills are expected to generalize better when training conditions resemble typical conditions.

    “New skills were expected to generalize better if conditions more closely approximated their typical conditions (Bouton, Woods, Moody, Sunsay, & Garcia-Gutierrez, 2006).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Bouton, Woods, Moody, Sunsay, & Garcia-Gutierrez, 2006

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The effectiveness of the intervention was tested through a randomized trial.

    “First, the effectiveness of the intervention was tested through a randomized trial.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Components involving parental sensitivity to child cues were excluded from the DEF control intervention to keep the interventions distinct.

    “Components that involve parental sensitivity to child cues were excluded in our version of the intervention so as to keep the interventions distinct.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study did not examine possible effects of the DEF comparison intervention.

    “Finally, we did not examine possible effects of the comparison intervention: Developmental Education for Families (DEF).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The study used the Strange Situation Procedure to measure children's attachment classifications.

    “Third, we used the Strange Situation Procedure to measure children’s attachment classifications in this study.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Inter-rater reliability for Strange Situation coding was 85% agreement for 4-way classifications (k=.74), 92% for secure/insecure, and 87% for organized/disorganized (k=.76).

    “The two coders agreed on 85% of the videos for 4-way classifications (k = .74), 92% of secure/insecure classifications, and 87% for organized/disorganized classifications (k = .76).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Children who experience early adversity may signal their needs unclearly, which can make sensitive parental responding difficult.

    “Children that experience adversity early in life may fail to signal their needs clearly (Stovall & Dozier, 2000; Stovall-McClough & Dozier, 2004), making it difficult for parents to respond sensitively.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Stovall & Dozier, 2000

      Not checked in the free run.

    • cites Stovall-McClough & Dozier, 2004

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Coder disagreements were resolved by conference, with Alan Sroufe conferring on especially difficult cases.

    “Disagreements were resolved by conference. Alan Sroufe was called in to conference on those that were especially difficult.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The DEF intervention was manualized, but specific activities took into account the child's developmental level.

    “Although the intervention is manualized, specific activities take into account child’s developmental level.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Sixty children were randomly assigned to the ABC intervention and 60 to the DEF control intervention.

    “Of the children included in this study, 60 were randomly assigned to receive the ABC intervention, and 60 were randomly assigned to receive the control (DEF) intervention.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All intervention sessions were videotaped so that fidelity to the manual could be assessed.

    “All sessions were videotaped, allowing assessments of fidelity to the manual.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Parents who did not experience sensitive care themselves often struggle to provide sensitive care to their children.

    “Often, parents struggle to provide sensitive care when they did not experience sensitive care themselves (Kovan, Chun, & Sroufe, 2009; van IJzendoorn, 1995).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Kovan, Chun, & Sroufe, 2009

      Not checked in the free run.

    • cites van IJzendoorn, 1995 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The second coder was Elizabeth Carlson, an expert in coding Strange Situations, who coded 34% of the videos.

    “The second of the two coders was Elizabeth Carlson, an expert in coding Strange Situations and, along with Alan Sroufe, the coding trainer for Strange Situations. Elizabeth Carlson coded 34% of the videos.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Maltreating parents and parents with unresolved trauma often behave in frightening ways with their children.

    “For example, maltreating parents and parents who have experienced unresolved trauma often behave in frightening ways with their children (Lyons-Ruth et al., 2005; Main & Hesse, 1990)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Lyons-Ruth et al., 2005 source

      Not checked in the free run.

    • cites Main & Hesse, 1990

      Not checked in the free run.

44 of 44

  • The paper relies on this without support.

    Caregivers of children with early adversity frequently do not have the means to give sensitive care, and in the absence of treatment they tend to keep exposing the child to harmful conditions instead of therapeutic parenting.

    “Parents whose children have experienced early adversity, however, are unlikely to have the resources to provide such care; without intervention, they often continue to expose children to adverse conditions rather than provide them with “therapeutic” parenting.”

  • The paper relies on this without support.

    The Strange Situation is the gold standard method for assessing children's attachment.

    “Given the strong psychometric properties and observational structure of the assessment, the Strange Situation Procedure has been considered the “gold standard” method for assessing children’s attachment.”

  • The paper relies on this without support.

    The DEF control intervention does not affect children's attachment outcomes.

    “Finally, we did not examine possible effects of the comparison intervention: Developmental Education for Families (DEF).”

  • The paper relies on this without support.

    Strange Situation classifications are valid for children older than 24 months.

    “Second, our use of the Strange Situation Procedure to assess attachment beyond 24 months extends beyond the range for which the procedure has been validated.”

  • The paper relies on this without support.

    Making parents aware of their automatic responses helps them recognize and override insensitive, controlling, or frightening behaviors.

    “By becoming aware of their automatic ways of responding to their children (“voices from the past”), parents became better able to recognize when they responded in insensitive, controlling, and/or frightening ways.”

  • The paper relies on this without support.

    Frequent positive in-the-moment feedback reinforces skills, supports parents, and enhances the parent-trainer relationship.

    “This frequent and positive “in the moment” feedback was expected to reinforce skills and ideas being discussed, support the parents’ efforts, and enhance the relationship between the parent and parent-trainer.”

  • The paper relies on this without support.

    Several previous intervention attempts have been ineffective or long-term.

    “This is particularly exciting given that several previous intervention attempts have either been ineffective or long-term.”

  • The paper relies on this without support.

    Previous research has highlighted effective components of early intervention programs.

    “Building on previous research highlighting effective components of early intervention programs, the current program was short-term and focused on specific behavioral targets.”

  • The paper relies on this without support.

    The sample of mothers is representative of mothers and young children who receive child protective services and are at risk for abuse and neglect.

    “Second, all of the mothers in the current study had been previously identified as being at-risk of maltreating their children. Therefore, the results of this study seem generalizable to mothers and young children who receive child protective services and are at risk for abuse and neglect.”
9 of 9

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • An RCT found that after treatment, ABC children showed less disorganized attachment (d=.52) and more secure attachment (d=.38) than children in a developmental education condition, even though pretreatment insecurity was similar.

    “Results indicated that children in the ABC treatment had lower rates of disorganized attachment (d = .52) and higher rates of secure attachment (d = .38) posttreatment relative to children in the other intervention despite having comparable rates of attachment insecurity pretreatment (Bernard et al., 2012).”

    From Relational Interventions for Maltreated Children (2017) · cites this paper as Bernard et al., 2012

  • ABC has been shown to improve attachment security.

    “Bernard et al. (2012) have previously shown that the ABC intervention was effective in enhancing attachment security.”

    From Intervening to enhance cortisol regulation among children at risk for neglect: Results of a randomized clinical trial (2015) · cites this paper as Bernard et al., 2012

  • The ABC intervention's effectiveness has been demonstrated for behavioral outcomes such as attachment organization and cognitive flexibility, and for biological outcomes.

    “Given that the effectiveness of the ABC intervention has now been demonstrated on both behavioral outcomes (i.e., attachment organization, Bernard et al., 2012; cognitive flexibility, Lewis-Morrarty, Dozier, Bernard, Terracciano, & Moore, 2012) and biological outcomes”

    From Intervening to enhance cortisol regulation among children at risk for neglect: Results of a randomized clinical trial (2015) · cites this paper as Bernard et al., 2012

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Secure-attachment total conflicts with group rates

    Major

    The study reports 60 children in each intervention group. The reported secure-attachment rates therefore imply 31 ABC children and 20 DEF children, or 51 in total, rather than the 50 stated in the classification summary. This discrepancy affects a primary outcome.

  • Biracial child percentage is rounded incorrectly

    Minor

    Of 120 children, 25 are 20.83%, which rounds to 21% at the reported precision, not 20%.

    Reported 20 · recomputed 20.833333

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Egeland, 1993, Prevention in mental health: Now, tomorrow, ever?, 21
  2. Heinicke, 1999, Relationship-based intervention with at-risk mothers: Outcome in the first year of life, Infant Mental Health Journal, 20, 349, 10.1002/(sici)1097-0355(199924)20:4&lt;349::aid-imhj1&gt;3.0.co;2-x · DOI
  3. Lyons-Ruth, 2008, Handbook of attachment: Theory, research, and clinical implications, 666
  4. Main, 1990, Attachment in the preschool years: Theory, research, and intervention, 161

Cited by

Sorted by citations

Related

Authors
Bernard, K., Dozier, M., Bick, J., Lewis-Morrarty, E., Lindhiem, O., & Carlson, E.
Affiliations
  • University of Delaware (US)
  • University of Delaware
  • University of Minnesota (US)
Corresponding author
Bernard, Kristin
ORCID
Venue
Child Development
Publisher
Oxford University Press (OUP)
Published
2012-03-01
Volume
83
Issue
2
Pages
623-636
ISSN
  • 0009-3920 (ISSN-L)
  • 1467-8624
DOI
10.1111/j.1467-8624.2011.01712.x
PMC
PMC3305815
OpenAlex
W2121953174
Semantic Scholar
3e4e4c3301fe96d7de3a442b519a4475d8b47f1e
Cited by
430
References
73
Citations by year
2026: 13 · 2025: 20 · 2024: 25 · 2023: 20 · 2022: 38 · 2021: 31 · 2020: 54 · 2019: 37 · 2018: 27 · 2017: 38 · 2016: 33 · 2015: 34 · 2014: 26 · 2013: 23 · 2012: 10
FWCI
44.88
Type
journal article
Language
en
Open access
Licence
Locations
  • Child Development (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH084135, R01MH052135, R01MH074374)
Topics
  • Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Safety Research › Child Welfare and Adoption
Keywords
Attachment and Biobehavioral Catch-up, disorganized attachment, secure attachment, child abuse, child neglect, childhood adversity, nurturing care, parent intervention, attachment quality, young children, Strange Situation
MeSH terms
Adolescent, Adult, Child Abuse, Child Welfare, Child, Preschool, Education, Female, Follow-Up Studies, Humans, Infant, Life Change Events, Male, Parent-Child Relations, Reactive Attachment Disorder, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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