The Course of Inattention and Hyperactivity/Impulsivity Symptoms After Foster Placement
ABSTRACT It is largely unknown whether symptoms of inattention and hyperactivity/impulsivity of foster children decline over time after placement and what the role of the quality and stability of the foster placement is on the course of attention-deficit hyperactivity disorder (ADHD) symptom trajectories. Longitudinal studies of normative trajectories of symptom types in nonreferred children may assist in appropriately diagnosing ADHD and designing the clinical treatment for foster children.
We described average level and slope of inattention and hyperactivity/impulsivity symptoms over time and examined parental (biological and foster) warmth and hostility and placement stability (number of foster-home moves and discharge from care) as reported by 3 informants (biological parent, foster parent, and classroom teacher) after considering maltreatment risks (child age, gender, sibling ADHD, and comorbidity) and use of ADHD medication.
We studied 252 maltreated children in 95 families during 4 yearly waves, beginning shortly after placement; children were assessed whether they remained in or were discharged from foster care.
Average level of inattention declined according to the biological parent, whereas hyperactivity/impulsivity symptoms declined according to both biological and foster parents. Higher inattention was associated with lower parental warmth (foster parent), higher parental hostility (biological, foster, and teacher), and discharge from care (biological parent). Higher hyperactivity was also associated with lower parental warmth (foster parent) and higher parental hostility (biological and foster parent), higher (average) number of foster-home moves, and discharge from care (biological report). Higher teacher-derived hyperactivity symptoms were associated with a history of child abuse (versus neglect); however, abused children showed a steeper decline of hyperactivity over time than those with neglect histories. Unexpected interactions were found for the impact over time of parental (foster) warmth and number of foster-home moves.
Findings point to the clinical usefulness of attending to the parenting quality and placement stability as malleable factors affecting symptom reduction subsequent to placement.
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- "Individual differences in emotionality have been largely attributed to cognitive regulation processes (Ochsner & Gross, 2008). Cognitive regulatory skills (which can include related processes such as inhibitory control, effortful control, cognitive control, and other executive functions) are often impaired following caregiving adversity in childhood (Garland et al., 2001; Lewis et al., 2007; Linares et al., 2010; Loman et al., 2013; Merz, McCall, Wright, & Luna, 2013; Pollak et al., 2010; Rogosch, Dackis, & Cicchetti, 2011; Simmel, Brooks, Barth, & Hinshaw, 2001; Steele & Buchi, 2008; Tottenham et al., 2010), in adolescence, and in adulthood (Bos, Fox, Zeanah, & Nelson Iii, 2009; Colvert et al., 2008; Mueller et al., 2010; Navalta, Polcari, Webster, Boghossian, & Teicher, 2006), as documented by both parent/self reports as well as laboratory-based performance (e.g., go/nogo tasks). Despite being highly modifiable by caregiving factors, cognitive regulatory skills are also influenced by factors other than caregiving (e.g., genetic polymorphisms, Smith, Kryski, Sheikh, Singh, & Hayden, 2013; reviewed in Barnes, Dean, Nandam, O'Connell, & Bellgrove, 2011). "
ABSTRACT: Individuals with a history of foster care (FC) are at elevated risk for emotion regulation-related mental illness. The purpose of the current study was to characterize regulatory function in a group of adults with a history of FC (N = 26) relative to those without a history of FC (N = 27) and how regulatory function moderates adverse caregiving-related outcomes (daily cortisol production and trait anxiety). Self-report items (anxiety, emotion regulation strategies, inhibitory control, caregiving history) were collected along with more objective measures (computerized task and salivary cortisol). Inhibitory control was assessed via self-report and a computerized task (emotional face go/nogo). Results showed that for adults with a history of FC, higher levels of inhibitory control were associated with higher accuracy on the emotional face go/nogo task and greater reported use of the emotion regulation strategy cognitive reappraisal. Greater use of cognitive reappraisal in turn was associated with healthier stress-related outcomes (decreased trait anxiety and steeper sloped cortisol production throughout the day). Dose-response associations were observed between self-reported regulatory skills and FC experiences (i.e., number of placements and age when exited foster care). These findings suggest that adverse caregiving can have long-term influences on mental health that extend into adulthood; however, individual differences in regulatory skills moderate these outcomes and may be an important target for intervention following caregiving adversity. © 2014 The Authors. Developmental Psychobiology published by Wiley Periodicals, Inc. Dev PsychobiolDevelopmental Psychobiology 01/2015; 57(1). DOI:10.1002/dev.21227 · 3.16 Impact Factor
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ABSTRACT: Although literature supports the association between harmonious coparenting practices and lowered child problems, little is known about coparenting influences among family constellations in the foster care system. Via a compilation of a new coparenting practices measure, we examined similarities and differences on foster parent-derived perceptions of support/flexibility, shared communication, conflict/triangulation, and total coparenting between foster and biological parents and their independent contribution to child internalizing and externalizing problems. Self-reports were gathered from foster parents (N=80) in 2 groups: kin and nonkin. As compared with nonkin, kin foster parents reported higher perceived support/flexibility, shared communication, and total coparenting. A tendency for higher conflict/triangulation among kin foster parents was also found. After considering foster parent group, psychological distress, and harsh discipline, hierarchical regression analyses revealed that perceived total coparenting and conflict/triangulation contributed to child internalizing and externalizing problems. Results support the linkage between perceptions of coparenting and child problems among caregivers (foster and biological alike) in kin and nonkin arrangements and highlight training in coparenting in general, and conflict management in particular, as an important intervention focus to reduce the high level of child problems in this vulnerable population.Family Process 12/2010; 49(4):530-42. DOI:10.1111/j.1545-5300.2010.01338.x · 1.73 Impact Factor
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ABSTRACT: How do adverse childhood experiences get 'under the skin' and influence health outcomes through the life-course? Research reviewed here suggests that adverse childhood experiences are associated with changes in biological systems responsible for maintaining physiological stability through environmental changes, or allostasis. Children exposed to maltreatment showed smaller volume of the prefrontal cortex, greater activation of the HPA axis, and elevation in inflammation levels compared to non-maltreated children. Adults with a history of childhood maltreatment showed smaller volume of the prefrontal cortex and hippocampus, greater activation of the HPA axis, and elevation in inflammation levels compared to non-maltreated individuals. Despite the clear limitations in making longitudinal claims from cross-sectional studies, work so far suggests that adverse childhood experiences are associated with enduring changes in the nervous, endocrine, and immune systems. These changes are already observable in childhood years and remain apparent in adult life. Adverse childhood experiences induce significant biological changes in children (biological embedding), modifying the maturation and the operating balance of allostatic systems. Their chronic activation can lead to progressive wear and tear, or allostatic load and overload, and, thus, can exert long-term effects on biological aging and health.Physiology & Behavior 08/2011; 106(1):29-39. DOI:10.1016/j.physbeh.2011.08.019 · 3.03 Impact Factor