A Systematic Review: Findings on Attachment Biobehavioral Catch up (ABC)

Background/Purpose:  The early developmental period for children is critical in terms of their future development. As children age, they become less susceptible to positive intervention influences, highlighting the need for early intervention and prevention efforts. The Attachment and Biobehavioral Catch-up (ABC) intervention is an early childhood evidence-based intervention, targeting parents of children at risk of maltreatment and adversities. This systematic review synthesized prior empirical literature from randomized control trials (RCT) on the ABC intervention to identify previously tested outcomes, characteristics of child samples, and other important traits of ABC implementation.

Methods: Studies included in this review utilized RCT procedures and presented early childhood outcomes. Guided by inclusion criteria and predefined search terms, articles were identified through searching numerous sources including: three electronic bibliographic databases, reference mining articles, hand searching journals, and gray literature.  Electronic databases yielded 55 articles while other sources yielded 138 articles. 144 unduplicated articles underwent a title and abstract review, and after applying inclusion criteria, nine articles remained for full-text review. Ultimately, the formal review included nine studies.  

Results: All nine studies used RCT procedures and methodology. Data extraction revealed that several of the included RCTs were follow-ups to a previously conducted RCT. Though nine articles were identified for inclusion, only three included studies utilized original datasets/samples. Eight of the nine studies took place in the Mid-Atlantic region. All studies’ samples included children and families previously or currently involved with the child welfare system. Outcome measures varied across studies and included: child internalizing/externalizing behavioral issues; perceptive language skills; cortisol regulation; and child attachment behaviors. Participants’ race varied, however, the majority of participants were African American, followed by White, then Hispanic. The ABC intervention was primarily implemented with children under 4 years old; one study implemented the intervention with children older than five. Overall, results from this review indicate that ABC improves emotion regulation for early childhood aged children at risk or experiencing maltreatment.

Conclusions & Implications: A Grand Challenge for the social work profession is to ensure healthy development of all youth. As such, there is a need to identify and disseminate the best interventions available for early childhood aged children experiencing adversities. ABC is identified as a best practice for early childhood, yet to date there has been no systematic review examining what child populations the intervention works best, what settings the intervention has previously been implemented, or what child outcomes ABC impacts. This review provides insight to these questions and highlights future areas for potential research and growth of the ABC intervention. Findings indicate evidence supporting ABC is strong yet somewhat limited in its generalizability, despite previously conducted RCTs. Barriers of current studies include limited variance in child samples, similar study settings, and reliance on child welfare involved samples.  Future research should test the ABC intervention in broader child serving systems (e.g. mental health system). Growing the literature supporting ABC as an intervention for young children will improve early childhood services.