Cognitive Flexibility and Theory of Mind Outcomes Among Foster Children: Preschool Follow-Up Results of a Randomized Clinical Trial

"Responsive caregiving early in life (i.e., parental sensitivity, secure attachment, and frequent coordinated social attention) has been associated with children's later self-regulatory, executive function, and theory of mind abilities."

From the abstract [footnotes have been removed by the editor throughout]: "Young children who experience early adversity are at risk for problems regulating emotions, behavior, and physiology, which in turn place them at risk for later psychopathology, school problems, and peer relation difficulties. Therefore, early parenting interventions are critical in helping this vulnerable population develop adequate self-regulatory capabilities. Attachment and Biobehavioral Catch-up (ABC) is an intervention developed to help parents learn to behave in ways that enhance young children's self-regulatory capabilities. In the present study, we found that preschool-aged foster children who had received the ABC intervention showed stronger cognitive flexibility and theory of mind skills, relative to foster children who had received a control intervention. Foster children who had received the ABC intervention showed capabilities in these areas that were not significantly different from a comparison group of children who were never in foster care. These findings are promising in suggesting that the ABC intervention enhances the development of foster children's self-regulatory capabilities."

This article analyses the development of young children's strategies for regulating their own emotions and behaviour:

• Executive functioning - cognitive processes that aid in the monitoring and control of emotions and behaviour, which include holding information in working memory, inhibiting impulses, planning, sustaining attention amid distraction, and flexibly shifting attention to achieve goals.
• Theory of mind - the ability to understand that others may have different emotions and motivations from one's own and that these inner states influence what people do.

Both executive function and theory of mind abilities develop rapidly between the ages of 3 and 6 years. Foster care placement increases the risk for later correlates of executive function deficits and deficits in theory of mind.

"...The Attachment and Biobehavioral Catch-up (ABC) intervention is a 10-session manualized parenting program aimed at enhancing young children's self-regulatory capacities by helping caregivers to provide nurturing and synchronous care. These two intervention components (i.e., nurturance in response to child distress and synchronous parent–child interactions) are targeted in a number of ways. Interventionists describe the importance of providing nurturing and synchronous care, based on developmental research. Additionally, interventionists videotape parent–child interactions during structured activities designed to help caregivers practice being synchronous by 'following the child's lead.' Interventionists provide feedback using video clips that highlight times when caregivers interacted with their children in nurturing and synchronous ways versus times when they struggled to do so (e.g., directing or teaching, intruding on the child's space, or being passive and disengaged). Finally, interventionists help caregivers consider how their own early experiences (e.g., not receiving nurturing care themselves) may make it more difficult to provide nurturing and synchronous care to their children."

This study followed a subset of children whose parents previously participated in a randomised trial of the ABC intervention when children were infants and toddlers. It examined executive function and theory of mind when children were preschoolers and concludes that the ABC intervention supports normative development of executive function and theory of mind capabilities by preschool age, outcomes important for school adjustment and social competence. "Our findings suggest the importance of early intervention for young children in foster care and demonstrate the potential protective power of enhancing the parent-child relationship in terms of young foster children's development of self-regulatory capabilities."