Maternal Psychological Risk Moderates the Impacts of Attachment-Based Intervention on Mother-Toddler Mutuality and Toddler Behavior Problems: A Randomized Controlled Trial

Background and Purpose: Given the central question in prevention research of “what works for whom?” and the documented relation of maternal psychological risk to parenting and intervention response, it is important to consider the moderating role of maternal psychological risk in the efficacy of attachment-based interventions. Further, although there is a robust literature on the benefits of attachment-based parenting interventions, limited research has examined the impact of such interventions on dyadic mutuality and toddler behavior problems.

Methods: The current study extends prior research on a randomized controlled trial of the Attachment and Biobehavioral Catch-up (ABC) intervention by examining the moderating role of maternal psychological risk in the impact of ABC on dyadic mutuality and toddler behavior problems. ABC (10 sessions) was provided as a supplement to Early Head Start (EHS) for a sample of low-income families (n=104). Control families (n=104) received home-based EHS plus 10 books sent to them weekly. The majority (87%) of mothers identified as Latina. Infants were an average of 13 months of age. We administered a psychosocial interview that included information on maternal maltreatment history (CTQ), intimate partner conflict (HITS), maternal depressive symptomatology (CESD), maternal anxiety symptoms (GAD), toddler behavior problems (BITSEA), and demographics. Dyadic mutuality was assessed via the “Three Bag” procedure, a video-recorded, coded parent-child interaction. Toddler emotional reactivity (co-variate) was derived from the Mask Task of the Lab-TAB.

Results: Using intent-to-treat analyses, we found main effects of ABC on dyadic mutuality (d = 0.27). We conducted latent class analysis to identify patterns of interrelationships among indicators of baseline maternal psychological risk (CESD, GAD, CTQ, HITS) to characterize a latent risk factor (72% of mothers low-risk; 28% high-risk). We used this factor to examine the moderating role of maternal psychological risk in ABC’s impact on dyadic mutuality and toddler behavior problems. Maternal psychological risk moderated ABC’s effects on dyadic mutuality (t = 3.05, p = .003) and toddler behavior problems (t = -2.62, p = .01). Specifically, ABC had more of an impact on dyadic mutuality and toddler behavior problems when mothers had higher levels of psychological risk.

Conclusions/Implications: In sum, we found that ABC had a main effect on dyadic mutuality, and that maternal psychological risk moderated ABC’s impact on dyadic mutuality and toddler behavior problems. These findings suggest that ABC may confer particular benefits on families at elevated risk, due to maternal mental health challenges and exposure to family conflict and childhood trauma. This study highlights the importance of targeted prevention programs, such as ABC, for families at risk for compromised parenting and child outcomes.