[audio:http://www.wdde.org/wp-content/uploads/2015/02/ABCPARENTING.mp3|titles= Delaware Public Media's Eli Chen examines the ABC parenting intervention program.]
Helping parents who’ve faced adversity has long been a challenge for child psychologists. The need to assist at-risk parents is becoming more imperative now that more studies show that children who are raised in poverty or abuse experience more difficulty academically, in their future relationships, and overall mental health. In a lot of cases, reading a book or taking a class on parenting may not be enough. Over the last three years, a University of Delaware professor has been developing a promising parenting intervention program that takes a more holistic approach to working with parents -- by sending coaches in the home to offer encouraging comments, as opposed to giving advice. Delaware Public Media’s science reporter Eli Chen went to find out what makes this parenting program successful.
One morning, about a couple weeks before Christmas, I went to Newark to visit a stay-at-home mother named Summer Campbell and her two-year-old daughter Sophia.
“This is Sophia. Sophia, can you say hi? Say 'hi' big girl...,” said Summer Campbell.
Sitting next to Sophia, surrounded by an entourage of toys, is Julie Hoye, a University of Delaware graduate student in psychology.
“She does love it when I imitate her,” said Campbell.
“But she feels so important, like when you reveal [the toy] like she does she feels like she is the center of the universe, that’s perfect," said Hoye.
Hoye is a parenting coach, but as you’ll hear, she’s an unusual one. She observes Campbell and Sophia playing and makes near constant commentary on what’s happening at the moment, what’s positive about what Summer is doing, and linking it all to why it’s important for Sophia.
Hoye works for Mary Dozier, a University of Delaware professor of psychology who created a parenting intervention program called ABC intervention -- which stands for Attachment Biobehavioral Catchup. The program is based on the attachment theory, the idea that humans, as well as other primates and mammals, are wired to form attachments, even bad ones.
“That’s been critical to our evolution over time that babies have to stay close to their caregivers and so even when caregivers are abusive or neglecting, babies are going to form attachments,” said Dozier.
The ABC intervention program focuses on at-risk parents, parents who’ve faced adversity in their lives, such as poverty or abuse. Dozier says there can be serious consequences if their offspring form unhealthy attachments.
“Babies with disorganized attachments are at a higher risk for showing problem behaviors like getting in trouble in school, substance abuse that sort of thing," said Dozier. "Also dissociative symptoms -- dissociative symptoms are things like being spacey and kind of out of it. At the extreme, that would be multiple personality disorder.”
There are three important ways ABC coaches try to “organize” these parent-child attachments. One, Julie comments when a parent acted nurturing, such as when a parent attends to a child falling from a chair. Two, Julie notes when the parent followed the child’s lead.
“Yeah, she points at something and you go follow her, that’s great following her lead. It makes her feel so important,” said Hoye.
And three, Julie recognizes when Summer avoided a behavior that could turn frightening or overwhelming, like when Summer playfully chased Sophia around the house, but then stopped herself before it got out of control.
“And that was a perfect example of like okay we can engage in this a little bit," said Hoye. "You’re so, so good at seeing those signs when she’s on that path and be like ‘Okay, we can be done now and I can help you calm down.’”
Dozier says even tickling qualifies as overwhelming.
“We really discourage parents from tickling. You just don’t need to be doing things to a child. If an uncle or relative does it, that’s one thing. But as the parent, you want to be the calm one, especially with children who’ve faced adversity, you want to be the one who calms them, not revs them up,” said Dozier.
Summer Campbell, who is 25, didn’t always have a good relationship with Sophia. If Sophia wasn’t cooperating, Summer used to yell at her without thinking about it. Then Sophia would run to her father, Dylan, who she could count on to be more gentle with her.
“If something happened and she ran to Dylan, it would hurt my feelings, it would make me upset it would resent Dylan a little bit. I birthed that child out of myself. They cut my stomach open. Why doesn’t she love me more? I couldn’t figure it out,” said Campbell.
But after Campbell went through the 10-session ABC program in August, and took anger management classes, she and Sophia are closer than ever. Before, Sophia wasn’t even comfortable with being even physically close to her mother. Now, she willingly climbs into her lap and plays with her.
“It was the simplest things. It was just like stop trying to teach her stuff and just interact with her. Tell her she’s doing a good job. Instead of putting these in the right order," said Campbell. "Parents are so used to trying to teach their kids things, they’re throwing out the fun part of it. That right there to just let her play--she likes to play with me more.”
ABC’s impact goes beyond family dynamics. Dozier’s research has shown effects that can be seen in the brain. Their studies have shown that high-risk children who go through the ABC intervention, compared those in a more standard intervention program, were less angry towards their parents, had more regulated stress hormone levels and tested well for something called “executive functioning.”
“The task we looked at was shifting sets, so you learn one rule, so can you shift to another rule. In this case, it’s sorting cards by shape, and then changing, sorting by color. And this is one of those things that at 3 years old, kids can’t do it, but at 4 a lot of them can," said Dozier. "What we found was striking differences between our ABC kids by the time they were 4, many more of those kids were able to shift sets effectively than the kids in the ‘control’ intervention.”
Dozier initially wasn’t expecting this result, but it’s important. Kids with better executive functioning are able to handle disappointment better and avoid conflicts. Dozier also followed these children years later, when they turned 8, 9, and 10 years old and found that many of the positive effects still remained.
Dozier’s lab also compared the brains of at-risk parents who participated in ABC intervention versus parents placed in a more standard intervention program, who represented the control group. In a study published in the journal Child Development, each parent looked a set of images of children in different emotional states -- content, upset, amused -- while researchers measured the changes in brain activity. With at-risk parents in the control group, there were generally no changes in brain activity when they looked at different expressions, but in ABC intervention participants, they found significant changes in brain activity.
“What we’re doing is that we’re getting them more finely attuned and so when the child’s distressed, instead of ignoring it, we’re getting them to say, ‘Oh honey, what’s the matter?’” said Dozier.
The ABC program is now operating in 11 states and a few countries abroad, including Norway and Australia -- and last year, it was given a number 1 rating -- the highest rating -- from the California Evidence-Based Clearinghouse for Child Welfare.
Other scientists are developing similar intervention programs for at-risk families. Katherine Rosenblum, a professor of psychiatry at University of Michigan at Ann Arbor has been working on a 13-session program called Mom Power. Parents and children gather at a community center and take part in activities aimed at helping them manage their stress.
“We really thought about what can we do to build a program that will meet the parents’ needs, so bringing families together, having a meal, connecting them with another and incorporating self-care skills, mindfulness exercises, deep breathing, things like them, really help them take care of their nervous system," said Rosenblum. "You need someone to help you soothe your nervous system, so you can help calm your child and soothe your child.”
Some features of these programs, such as their short timeframes, help make them effective. But the primary reason they work is because the coaches place the utmost respect for the parents.
“Parenting is a tough task, good grief.” said Douglas Powell, a distinguished professor of human development and family studies at Purdue University, who also sees specific strengths in the ABC approach.
“The mother can easily see this home visitor is on my side, this home visitor acknowledges what I’m doing here, sees the strengths in my parenting," saoid Powell. "When we hear positive things about what we’re doing, we want to do more of it. It’s an affirmation of our work.”
Even though Summer’s relationship with Sophia has improved, she still has moments where she feels challenged.
“Taking her out into public is not an option anymore,” said Campbell.
“What happened?” asked Hoye.
“She’s insane,” Campbell responded.
But Julie’s commentary helps override the negative thoughts in Campbell’s head. Now, she takes a moment to pause and try to understand what Sophia is going through.
“When I make her mad and she starts to cry and instead of saying it’s okay, it’s okay, it’s okay. I say, I know, I get it, we can go outside later,” said Campbell.
After all, Sophia’s just a kid who’s still learning. As she gets older, there will be moments she gets scared or runs into trouble. But as long as Campbell continues to be sensitive to her, Sophia will know that at least, no matter what, she can count on her mother.