Enhancing Self-Regulation and Language in Children with Adverse Childhood Experiences

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Emma H. Hinzman

A paper submitted to the faculty of the Department of Natural Sciences, Southeastern

University, in partial fulfillment of the requirements of Senior Capstone

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Abstract

Children with multiple adverse childhood experiences (ACEs) are at risk of developing a
dysregulated stress response system, potentially causing self-regulation and language deficits.
Recognizing the significance of attachment for children’s cognitive, language, social, and
emotional engagement, this research proposal advocates for the use of the Attachment and
Behavioral Catch-Up (ABC) Intervention, specifically for foster care children and their foster
parents. The present study aims to reduce the risk of self-regulation and language deficits, build
language skills through enhancing self-regulation in children with adverse childhood
experiences, and assess the long-term effects of the Attachment and Behavioral Catch-Up (ABC)
Intervention. Expected outcomes propose that improved attachment with a caregiver will lead to
increased self-regulation and language skills in children with adverse childhood experiences.
___________________________________________________________________________________

Key Words: adverse childhood experiences (ACE), stress response system, self-regulation,
language, Attachment and Biobehavioral Catch-Up (ABC) Intervention, foster care
Background

Adverse Childhood Experiences

Adverse childhood experiences (ACEs) are traumatic experiences that occur before the

age of 18. These events include all forms of childhood maltreatment, which are physical abuse,

emotional abuse, physical neglect, and emotional neglect. Neglect can be divided into four

categories, including occasional inattention, chronic under-stimulation, severe neglect in a

family context, and severe neglect in an institutional setting. Occasional neglect is healthy and

helps children develop the ability for self-soothing. Chronic under-stimulation is when a child

experiences a lack of interaction with caregivers on a regular basis. This type of neglect can lead

to developmental delays as well as

a variety of other factors. When a

baby is not being attended to, the

stress systems of their body

become activated. To them, this is

a sign of danger. Key synapses that

are formed in the brain will fail to

develop because of the body’s

ongoing activated stress response.

Severe neglect in an institutional

setting is when basic needs are met but one-on-one supportive adult interaction is not received

by the child (National Scientific Council on the Developing Child, 2012). ACEs also include

household dysfunction, such as parental incarceration, domestic violence, household mental

illness, household substance abuse, and parental separation or divorce (Burke Harris, Dr. N.,

2019).

ACEs have the potential to subject the body to toxic stress. There are three types of stress,

including positive stress, tolerable stress, and toxic stress. Positive stress is healthy and normal;

this helps children learn how to self-soothe. Tolerable stress is more severe than positive stress

but manageable with things like support from a healthy adult. Toxic stress, however, is a severe

and prolonged, frequent type of stress. This is what is often seen in children with multiple ACEs.

Recurring child abuse is an example of an individual with an ACE with toxic stress (Center on

the Developing Child at Harvard University, 2020). Child maltreatment is the second leading

cause of death among children under the age of one, and there is a 30-60% co-occurrence rate of

child maltreatment and its risk factors, which are poverty, parental alcohol, parental drug

abuse, and domestic violence (Brown CL, Yilanli M, Rabbitt

AL., 2023). Research has shown that, while poverty may not

be considered an ACE, it has been strongly linked as being

an increased risk for adverse experiences (Hughes, M., &

Tucker, W., 2018). The other risk factors are types of ACEs.

This statistic demonstrates the probability of a child having

more than one ACE. When a child experiences a frequency

of ACEs, they are in danger of a dysregulated stress

response system. In typical fashion, the amygdala detects a

threat or stressor, sending the HPA axis into gear. This system includes the hypothalamus,

pituitary gland, and adrenal glands. The HPA axis is what tells the body to react to stress,
through the release of the stress hormone, cortisol. The prefrontal cortex would then regulate

the body’s stress response. When a child experiences recurrent ACEs, the body may experience

toxic stress. This could mean that the amygdala is constantly detecting stress, sending it to the

HPA axis. The body is not meant to be in a constant state of fight or flight. The prefrontal cortex

may not be able to regulate the body’s stress response. (Murphy et al., 2022) All of this can cause

much harm. Even if a child does not remember trauma, the body does (Burdick, 2023).

According to the Burke Foundation Report, in the United States, around 50% of children acquire

ACEs by the age of 3. Children with multiple ACEs are twice as likely to be disengaged in school,

more likely to drop out of high school, and have an increased risk of low educational

performance and behavioral problems. Those with 2 or more ACEs are 3 times more likely to fail

a grade. ACEs can alter the body and the brain’s structure, likely affecting a child emotionally,

physically, and educationally (Burke Harris, Dr. N., 2019).

Attachment

Attachment is the emotional bond formed between a child and their caregiver, and

serve-and-return interactions are a large component of building healthy attachment. When

children experience healthy attachment, toxic stress is most likely mitigated. Healthy

attachment is supportive and engaging, fostering a child’s cognitive, language, social, and

emotional engagement, promoting self-regulation, stress management, social competence, and

language skills (Institute of Medicine and National Research Council, 2015). These

serve-and-return interactions are when a caregiver fosters back-and-forth interactions, such as

a baby “serving” by babbling and the caregiver “returning” by responding. Emotion regulation,

language, and abstract thought rapidly develop in the first 3 years of life, with a child’s
environment heavily influencing this early development (Child Welfare Information Gateway

2023). According to the Center on the Developing Child at Harvard University (2020), healthy

caregiver-child interactions, involving serve-and-return (Center on the Developing Child at

Harvard University, 2020) strengthen a baby’s neuronal pathways by meeting physical and

emotional needs (Harvard University, 2020). From an early age, these back-and-forth

interactions teach children how to have a conversation, building language development.

Attachment is providing that one-on-one basis for a foundation, and brain development is

enhanced through serve-and-return interactions because synaptic connections are reinforced

through this repetition of interactions, strengthening those neuronal pathways. When babies

and children do not receive the healthy attachment that they need with their caregivers,

developmental delays are a risk.

The Relationship between Self-Regulation and Language

When a child experiences healthy attachment and

serve-and-return interactions, self-regulation is promoted,

fostering language skills. The two can go hand in hand with

one another. The relationship between self-regulation and

language is focal in the context of children with adverse

childhood experiences, as frequent trauma exposure can

disturb the development of self-regulation, a prime

component of emotional and cognitive control, in turn, affecting language development (Center

on the Developing Child at Harvard University, 2020). Research demonstrates that better

self-regulation skills show higher language skills (Eisenberg, Sadovsky, & Spinrad, 2005).

Self-regulation is the ability to identify and manage one's behavior and emotions in order to
participate in executive functions, which include working memory, attention, and inhibitory

control (Murray et al., 2016). When children do not

experience healthy attachment, which requires

serve-and-return interactions, they do not feel the

freedom and encouragement to explore, learn, and

manage their emotions appropriately (Montroy et al.,

2016). Emotional regulation and attention, components of

self-regulation, foster language skills. When children are

able to regulate their emotions and maintain attention, they are able to learn through imitation

and participation in conversation. On the other hand, this is another reason a child’s

environment is so crucial. If caregivers are not facilitating a safe and learning-rich environment,

their development is at risk of a developmental delay.

Methodology

In order to take steps to reduce the possible impacts of ACEs, the Attachment and

Behavioral Catch-Up Intervention is employed to help reduce the impacts of adverse childhood

experiences. The Attachment and Behavioral Catch-Up (ABC) Intervention aims to help

caregivers respond appropriately to their child when they are unable to regulate their emotions

(Dozier, 2020). The present study is specifically designed to help foster parents navigate helping

their foster child emotionally regulate in order to ensure language development is caught up to

same-aged children without ACEs. The study aims to reduce the risk of self-regulation and

language deficits. Self-regulation fosters higher language skills. Through targeting parental

sensitivity, the study seeks to mitigate the risk of language deficits as well. In order to see typical

development in foster children with adverse childhood experiences, the ABC Intervention aims
to prevent deficits and build typical language development through strengthening

self-regulation skills. The long-term effects of the intervention are investigated.

In order to be qualified as participants, foster children had to be screened through the

ACEs screener by a foster parent or case worker. Children in the research study are between the

ages of three and five, have more than one ACE, and are in foster care. In order to assess

self-regulation and comprehensive language skills, children are assessed before and after

intervention. For self-regulation, the Behavior Assessment System for Children Third Edition

(BASC-3) will be used before intervention, 6 months post-intervention, and annually until 10

years old. For a comprehensive language assessment, a Sampling Utterances Grammatical

Analysis Revised (SUGAR) language sample and the Comprehensive Assessment of Spoken

Language, Second Edition (CASL-2) will be used before the intervention, 6 months

post-intervention, and annually until 10 years old. The ABC Intervention is 10 weeks for 1 hour

each session. Sessions will

include “in-the-moment”

feedback, video feedback,

and manualized

discussions. In-the-moment

feedback included three

components. The parent

coach will describe the child’s behavior and the parent’s response, describe how the parent

integrated the intervention focus, and include a potential outcome for the parent’s response

(Dozier, 2017). Sessions 1 and 2 will focus on reinterpreting child behaviors. Sessions 3 and 4 will
help caregivers follow the child’s lead when unable to emotionally regulate. Sessions 5 and 6

will help caregivers identify their own behaviors that may be perceived as frightening or

overwhelming and develop new responses. Sessions 7 and 8 will help caregivers parent from a

nurturing and supportive standpoint instead of past experiences (override voices of the past),

and sessions 9 and 10 will reinforce previous sessions (Dozier, 2020). Comparison groups

include another treatment called the Developmental Education for Families (DEF) Intervention,

which has the same qualifications to be a participant as the ABC Intervention. The DEF

Intervention targets developmental milestones and utilizes video feedback, Both the DEF and

ABC Interventions are ten weeks for one hour each session (Dozier, 2017). The other group is a

low-risk comparison group, which will receive no intervention. This group consists of three to

five-year-olds with no ACEs, those who have never entered foster care, and those who have been

raised by their birth parents.

Discussion

Expected outcomes are that the ABC Intervention will improve self-regulation and

language skills among children with adverse childhood experiences via improving attachment

with caregivers. Because a child’s environment is linked to cognitive and emotional

development, improving the attachment between foster parents and their foster children will

promote higher self-regulation and language skills. The intervention seeks to provide the

emotional and cognitive tools they need. The goal of intervention is to improve how parents

respond when a child with ACEs is unable to emotionally regulate, self-regulation skills will be

enhanced in early and middle childhood and consequently promote higher language skills.
 References

ACES Aware. (2023, March 16). Screening tools. ACEs Aware.

https://www.acesaware.org/learn-about-screening/screening-tools/

Dozier, M., & Bernard, K. (2017). Attachment and Biobehavioral Catch-up: Addressing the Needs

of Infants and Toddlers Exposed to Inadequate or Problematic Caregiving. Current

opinion in psychology, 15, 111–117. https://doi.org/10.1016/j.copsyc.2017.03.003

Dozier, M. (2020, September 23). The attachment biobehavioral catch-up (ABC) intervention.

THE ATTACHMENT BIOBEHAVIORAL CATCH-UP (ABC) INTERVENTION.

https://kslegresearch.org/KLRD-web/Publications/Resources/Documents/FosterCareO

versight/memo_genl_deboer_abc_intervention.pdf

Eisenberg, N., Sadovsky, A., & Spinrad, T. L. (2005). Associations of emotion-related regulation

with language skills, emotion knowledge, and academic outcomes. New directions for

child and adolescent development, (109), 109–118. https://doi.org/10.1002/cd.143

Hughes, M., & Tucker, W. (2018). Poverty as an Adverse Childhood Experience. North Carolina

medical journal, 79(2), 124–126. https://doi.org/10.18043/ncm.79.2.124

Institute of Medicine and National Research Council. 2015. Transforming the Workforce for

Children Birth Through Age 8: A Unifying Foundation. Washington, DC: The National

Academies Press. https://doi.org/10.17226/19401.

Issue briefs | March 2023 - Child Welfare Information Gateway. (2023, March).
 https://www.childwelfare.gov/pubPDFs/brain_development.pdf

Julieburdick, J. R. (2023, May 8). Children may not remember trauma, but their bodies do. KVC

Health Systems.

https://www.kvc.org/blog/children-may-not-remember-trauma-but-their-bodies-do/#:

~:text=Kids%20who%20experience%20childhood%20trauma,reveals%20that%20their%

20bodies%20do.

Lind, T., Lee Raby, K., Caron, E. B., Roben, C. K., & Dozier, M. (2017). Enhancing executive

functioning among toddlers in foster care with an attachment-based intervention.

Development and Psychopathology, 29(2), 575–586.

https://doi.org/10.1017/s0954579417000190

Montroy JJ, Bowles RP, Skibbe LE, McClelland MM, Morrison FJ. The development of

self-regulation across early childhood. Dev Psychol. 2016 Nov;52(11):1744-1762. doi:

10.1037/dev0000159. Epub 2016 Oct 6. PMID: 27709999; PMCID: PMC5123795.

Murphy, F., Nasa, A., Cullinane, D., Raajakesary, K., Gazzaz, A., Sooknarine, V., Haines, M., Roman,

E., Kelly, L., O'Neill, A., Cannon, M., & Roddy, D. W. (2022). Childhood Trauma, the HPA

Axis and Psychiatric Illnesses: A Targeted Literature Synthesis. Frontiers in psychiatry,

13, 748372. https://doi.org/10.3389/fpsyt.2022.748372

Murray, D.W., Rosanbalm, K., and Christopoulos, C. (2016). Self Regulation and Toxic Stress:

Seven Key Principles of Self Regulation in Context. OPRE Report #2016-39. Washington,

DC: Office of Planning, Research, and Evaluation, Administration for Children and
 Families, US. Department of Health and Human Services.

National Scientific Council on the Developing Child. (2012). The Science of Neglect: The

Persistent Absence of Responsive Care Disrupts the Developing Brain: Working Paper 12.

http://www.developingchild.harvard.edu

NJ ACEs Opportunities Report. (2019, July 30). Retrieved from

https://aces-report.burkefoundation.org/wp-content/uploads/2019-NJ-ACEs-Opportun

ities-Report.pdf

NJ Funders Aces Collaborative - aces-report.burkefoundation.org. (n.d.).

https://aces-report.burkefoundation.org/wp-content/uploads/2019-NJ-ACEs-Opportun

ities-Report.pdf

Toxic stress. Center on the Developing Child at Harvard University. (2020, August 17).

https://developingchild.harvard.edu/science/key-concepts/toxic-stress/