Reducing Behavior Problems in Children Adopted Internationally: Evidence from Attachment and Biobehavioral Catch-up

• In Event: Early Childhood Parent Coaching Interventions: Examining Adaptations and Coaching Process

Abstract

Following international adoption children often face continued difficulties with behavior problems. The current randomized controlled trial assessed whether 122 children adopted internationally whose parents were randomized to receive an adapted version of the Attachment and Biobehavioral Catch-up intervention (ABC; Dozier & Bernard, 2019), a preventative intervention that utilizes parent coaching, demonstrated fewer behavior problems on parent-reported and observational assessments of externalizing behavior than children randomized to receive a control condition (DEF; Ramey et al., 1984). Behavior problems were assessed via parent-report using the Brief Infant Toddler Social Emotional Assessment (BITSEA; Briggs-Gowan & Carter, 2006) before randomization and after the intervention when children were between 18 and 36 months and observationally using the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS; Wakschlag, Briggs-Gowan, et al., 2008a; Wakschlag, Hill, et al., 2008b) when children were 48 and 60 months old. At the time of the first pre-intervention visit, children were on average 21.55 months old (SD = 8.22) and 52.5% (n = 64) were female. Piece-wise hierarchical linear growth modeling was used to analyze changes in parent-reported behavior problems through 28 months post-intervention. One-way analyses of variance were used to examine intervention effects on observed behavior problems during the DB-DOS in three contexts (the Parent Context, Examiner Busy Context, and Examiner Present Context). Children whose mothers participated in ABC reported significantly fewer parent-reported behavior problems than children whose parents participated in the control condition at the first post-intervention visit. Specifically, children in DEF were estimated to show mean levels of behavior problems of 9.17 (β00), whereas children in ABC were estimated to have mean levels of behavior problems of 6.99 (β00 + β01) at the first post-intervention visit. This represented a medium effect size (d = 0.68). The significant effect of the intervention on the post-intervention parent-reported behavior problems remained significant through 13 – 18.99 months post-intervention. See Figure 1 for a depiction of change in parent-reported behavior problems across time. On the DB-DOS, intervention effects were only observed in the Parent context when children were 48-months-old, which was on average 2.00 years (SD = .86) post-intervention. When controlling for time institutionalized, children in ABC were observed to engage in fewer behavior problems than children in DEF; F(1, 75) = 5.52, p = .02 (see Figure 2). To our knowledge, these results are the first to demonstrate that an early parenting intervention is effective at reducing behavior problems among children adopted internationally.

Authors

• Heather Yarger, University of Maryland - College Park
  Presenting Author

• Teresa Lind, San Diego State University
  Non-Presenting Author

• Lee Raby, University of Utah
  Non-Presenting Author

• Lindsay Zajac, Children’s Hospital of Philadelphia
  Non-Presenting Author

• Mary Dozier, University of Delaware
  Non-Presenting Author