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The Effects of Early Severe Psychosocial Deprivation on Children’s Cognitive and Social Development: Lessons from the Bucharest Early Intervention Project
Abstract
Developmental psychologists have long been interested in understanding the effects of early experience on brain and behavior. Much of the research in this area has been with rodents and nonhuman primates. There are, however, situations in which infants and young children are exposed to severe psychosocial deprivation that are amenable to the study of early experience. Infants raised in institutions represent such a group. Indeed, the institutionalization of infants and young children is a worldwide problem, and the study of the effects of this early experience on child development, as well as potential interventions for children in these situations, is of public health importance. This chapter presents an overview of one such study: the Bucharest Early Intervention Project (BEIP). One hundred thirty-six infants and young children living in institutions in Romania were randomized either to be placed in foster family care contexts (foster care group) or to remain in the institutions in which they lived (care as usual group). These children were assessed at 30, 42, 54, and 96 months of age across a broad set of domains. This chapter presents data on two such domains: IQ and attachment. Findings from the BEIP suggest that institutionalization is detrimental to the cognitive and social development of children and that infants and young children living in such situations should be placed as early as possible into family contexts.
... Third, whether these trajectories vary with child age, sex and type of reintegration package received is not clear. Child age and sex have been shown to moderate global and domain-specific psychopathology among institutionalised children and their recovery patterns following foster care placement (Bos et al., 2011;Fox et al., 2013). Both RCTs and longitudinal studies report that boys manifest more psychiatric symptoms than girls regardless of caregiving environment and are less likely to recover following foster placement (Bellamy, 2008;Fox et al., 2013), yet crosssectional studies report more internalising problems among institutionalised girls and older children than boys and younger children respectively (Nsabimana et al., 2019). ...
... Child age and sex have been shown to moderate global and domain-specific psychopathology among institutionalised children and their recovery patterns following foster care placement (Bos et al., 2011;Fox et al., 2013). Both RCTs and longitudinal studies report that boys manifest more psychiatric symptoms than girls regardless of caregiving environment and are less likely to recover following foster placement (Bellamy, 2008;Fox et al., 2013), yet crosssectional studies report more internalising problems among institutionalised girls and older children than boys and younger children respectively (Nsabimana et al., 2019). ...
This longitudinal study examined the psychosocial health trajectories of children following reunification from residential care and the associated contextual factors. Data were drawn from a randomised controlled trial evaluating the effects of a parenting programme on the successful reunification and reintegration of 1–13-year-old children with their families, in nine districts in Uganda. Families were randomised to receive either a basic reintegration package consisting of a reunification grant and case management (standard intervention) or an enhanced package consisting of the basic package plus 13 bi-weekly training sessions of a parenting programme (enhanced intervention). Data were collected from caregivers at home and the residential care facilities, as well as the children (n = 55 dyadic pairs) through prospective interviews at baseline (before reunification), and at 6- and 12-months post-reunification. Predictive growth curve analyses assessed longitudinal changes in child psychosocial problems (externalizing, internalizing, total behavioural problems) and associated contextual factors. In age, sex, and study arm stratified analyses, we found declining linear trajectories in children’s psychosocial problem scores at 6 and 12 months post-reunification. Taking covariates into account, persistent externalizing, internalizing, and total behavioural problems at endline were associated with children’s depressive symptoms, caregiver characteristics and quality of caregiving. Our findings suggest that children who are reunified from residential to family-based care have fewer psychosocial problems post-reunification compared to their time in residential care. These findings did not differ by age and sex of the child or type of reintegration package received. Although findings from our small single study have limited generalizability and should be interpreted with caution for policy and programming, they underscore the potential benefits of reunification programmes for children’s psychosocial well-being.
... The early conceptualization of this idea began "in the 1940's" when Hebb first proposed a theory that early environmental enrichment could promote structural changes in the brain and thus enhance brain development (8). Recent research has extended these findings by investigating the biological mechanisms by which early psychosocial factors influence neuronal development (9)(10)(11)(12). This evidence supports a neuropsychological perspective, whereby human development is shaped by the interaction of biology and social experience, rather than simply "unfolding" as a predetermined sequence of developmental stages (13). ...
Social communication forms the foundation of human relationships. Social communication, i.e., the appropriate understanding and use of verbal and non-verbal communication within a social context, profoundly impacts mental health across the lifespan and is also highly vulnerable to neurodevelopmental threats and social adversities. There exists a strong interconnection between the development of language and other higher cognitive skills, mediated, in part, through the early attachment relationship. Consideration of how attachment links to brain development can help us understand individuals with social communication difficulties across the lifespan. The early attachment relationship supports the development of the foundational constructs of social communication. In this paper, a neuropsychological perspective was applied to social communication, which integrated evidence from early attachment theory, examining the underpinnings of social communication components identified by the SoCom model, namely socio-cognitive, socio-emotional, and socio-linguistic constructs. A neuropsychological perspective underscores the importance of interdisciplinary collaboration. This should also inform approaches to prevention, policy, intervention, and advocacy for individuals with or at risk for social communication impairments, as well as their families.
This study examined if considerably different caregiving experiences in infancy influence socio-emotional development later in childhood. We included children aged 6-9 years who were, immediately after birth, placed in quality state-run institutions (N = 24) or quality state-run foster care with one family (N = 23). All children have lived in stable families since their adoption before 15 months of age. Children in the comparison group have always lived with their biological parents (N = 25). We found that the previously institutionalized group had significantly more behavioral problems, more dissociative symptoms, and lower empathic behavior scores than the comparison group. The previously fostered group also exhibited more behavioral problems and dissociative symptoms than the comparison group but, notably, significantly fewer behavioral problems than the previously institutionalized group. The findings underscore the beneficial role of foster care compared to institutional care and that quality and consistency of early caregiving play a crucial role in later socio-emotional development.
This Element builds on the mainstream theory of attachment and contemporary understanding of the environment of evolutionary adaptedness to address the origin and nature of infant-maternal bond formation. Sections 2 and 3 propose that attachment behaviors for protesting against separation and usurpation were compelled by infants' needs for close and undivided access to a source of breast milk, usually mothers, for three years to counter threats of undernutrition and disease that were the leading causes of infant mortality. Since these attachment behaviors would not have been presented unless they were compelled by maternal resistance, their arising is also attributed to parent-offspring conflict. Section 4 theorizes that the affectional nature of infant-maternal attachment originated within contexts of breastfeeding. Uniform and universal features of exclusive versus complementary breastfeeding, that could entail diverse experiences among multiple caregivers, may have shaped adaptations so that love relationships with mothers differ from those with nonmaternal caregivers.
The present study sought to compare 4 groups of age- and gender-matched children-(a) those reared in institutions for children without parental care in Russia; (b) those raised by their biological parents in Russia; (c) those adopted to the United States from Russian institutions; and (d) those born in the United States and raised by their biological parents-on indicators of cognition, language, and early learning. In addition, we aimed to compare the effects of the length of time spent in an institution, the age of initial placement in an institution, the age at adoption, and pre-institutional risk factors (i.e., prenatal substance exposure and prematurity and low birth weight) on the above-mentioned outcomes in the 2 groups of children with institutionalization experiences. Our results confirm previous reports demonstrating negative consequences of institutionalization and substantial ameliorating effects of adoption. They also underscore the complexity of the effects of institutionalization and adoption, showing that they are intertwined with the effects of pre-institutional risk factors. (PsycINFO Database Record
Developmental disabilities are increasingly recognized, and remarkable progress is being made on the genetic and neurobiological underpinnings of many disorders. Yet, only a tiny percentage of the disability literature addresses families of children with disabilities. A review of recently published family studies reveals salient trends and gaps.
Consistent with previous work, high levels of parent stress, illness, anxiety, and depression are apparent. Studies in the USA focused on parents of children with autism; in contrast, studies on parents of children with intellectual disabilities were almost always conduced abroad. Compared to other disabilities, families of children with psychiatric disorders and genetic syndromes are understudied. The majority of family studies are descriptive, with very few trials or interventions aimed at reducing parental stress. Of these, mindfulness practices and a peer-mentor model of treatment delivery hold much promise for effective stress reduction. Psychoeducational programs and respite care are differentially beneficial.
A new era of family intervention research is in order. This work can take advantage of many advances in telemedicine, peer-mentor models, smart technology, and biomarkers as indices of change. Benefit could also stem from group interventions with parents who share similar concerns, regardless of their child's diagnostic label.
The study reported by Shihning Chou and Kevin Browne explored the link between institutional care for young children and international adoption, using a survey of 33 European countries. Official figures were available from 25 countries on the proportions of national versus international adoption within their own countries, together with the number of children under three in institutional care. Results indicate an association between international adoption (both incoming and outgoing) and a high number of young children in institutional care. The evidence suggests that, rather than reduce the number of children in institutions, international adoption may contribute to the continuation of this harmful practice. A child rights-based approach to providing alternative care for children separated from their parents is proposed.
Following earlier experimental studies comparing institution and foster-home children (see
17: 3268;
18: 2307, 2637, 3915), the author has made intensive investigations of the life histories of 15 adolescent institution children. These life histories tend to confirm the previous conclusion that infant deprivation results in a basic defect of total personality manifest especially as a defect in concept formation and as an attitude of passivity and emotional apathy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This report is concerned with behavioral development in an institution whose care of infants is in some respects identical with, and in some respects quite different from, that described in other studies. The data were obtained in a foundling home in Beirut, Lebanon, which, because of inadequate financial support, is able to provide little more than essential physical care. The institution in which the study was conducted will be called the Creche, although this is not the formal name of the home. For the subjects under one year of age the Cattell infant scale was employed. We tested all subjects who fell into our age categories upon two series of testing dates. In summary, the data show that, with respect to behavioral development, children in the Creche are normal during the second month of age, are greatly retarded from 3 to 12 months of age, and almost normal on certain performance tests between 4.5 and 6 years of age. It was found that in terms of developmental quotients, the mean quotient at two months was approximately 100. It is believed that the objective data of other studies, as well as this one, can be interpreted in terms of the effects of specific kinds of restrictions upon infant learning. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Ecology of Institutional LifeDevelopmental Problems Associated with InstitutionalizationDisturbances of Attachment and Institutional CareOther Problems in Young Children Associated with Institutional RearingConclusions and Future Directions
Inequality between and within populations has origins in adverse early experiences. Developmental neuroscience shows how early biological and psychosocial experiences affect brain development. We previously identified inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anaemia as key risks that prevent millions of young children from attaining their developmental potential. Recent research emphasises the importance of these risks, strengthens the evidence for other risk factors including intrauterine growth restriction, malaria, lead exposure, HIV infection, maternal depression, institutionalisation, and exposure to societal violence, and identifies protective factors such as breastfeeding and maternal education. Evidence on risks resulting from prenatal maternal nutrition, maternal stress, and families affected with HIV is emerging. Interventions are urgently needed to reduce children's risk exposure and to promote development in affected children. Our goal is to provide information to help the setting of priorities for early child development programmes and policies to benefit the world's poorest children and reduce persistent inequalities.
Early life events can exert a powerful influence on both the pattern of brain architecture and behavioral development. In this study a conceptual framework is provided for considering how the structure of early experience gets "under the skin." The study begins with a description of the genetic framework that lays the foundation for brain development, and then proceeds to the ways experience interacts with and modifies the structures and functions of the developing brain. Much of the attention is focused on early experience and sensitive periods, although it is made clear that later experience also plays an important role in maintaining and elaborating this early wiring diagram, which is critical to establishing a solid footing for development beyond the early years.
Powerful advances in neuroimaging techniques have added to and refined classical descriptions of the neurobiology of language in adults. Recent studies have employed these methodologies to study the nature and extent of plasticity of language-relevant aspects of cerebral organization in adults, in early and late bilinguals and in people who have acquired language through different modalities. Studies of children have documented dynamic shifts in cerebral organization over the course of language acquisition. Each of these different approaches has revealed constraints on the identity of the neural systems that mediate language; these studies have also described the marked and specific effects of language experience on the organization of these systems.
Visual acuity was assessed in 28 human infants who had been deprived of all patterned visual input by cataracts in one or
both eyes until they were treated at 1 week to 9 months of age. Immediately after treatment, acuity was no better than that
of normal newborns. Acuity improved significantly over the next month, with some improvement apparent after as little as 1
hour of visual input. Unlike findings at older ages, the pattern of results was the same for eyes treated for monocular and
for binocular deprivation. The results indicate that patterned visual input is necessary for the postnatal improvement of
human visual acuity and that the onset of such input initiates rapid functional development.
Associations between experiences and outcomes could be due to (a) continuation of adversity or (b) organismic changes, including experience-expectant and experience-adaptive developmental programming. The adoption into British families of children who had been reared in profoundly depriving institutions in Romania presented an opportunity to test mechanisms. Romanian children reared from infancy in very depriving institutions for periods up to 42 months were compared with 52 nondeprived UK-born children placed into adoptive families before the age of 6 months. The results at 6 years of age showed substantial normal cognitive and social functioning after the provision of family rearing but also major persistent deficits in a substantial minority. The pattern of findings suggests some form of early biological programming or neural damage stemming from institutional deprivation, but the heterogeneity in outcome indicates that the effects are not deterministic.
This paper aims to compare orphans' development in two different care systems.
Based on age, sex, psychological trauma scores, competence and psychological problem scores, two comparable samples were found representing orphans in the traditional foster care (n = 94) and the orphanages (n = 48) in a middle-large city in Iraqi Kurdistan. At an index interview, Child Behaviour Checklist (CBCL), Harvard-Uppsala Trauma Questionnaire for Children and Post-traumatic Stress Symptoms for Children (PTSS-C) were administered to the caregivers. After 1 year the CBCL, and after 2 years both the CBCL and the PTSS-C, were-re-administered, consecutively.
Although both samples revealed significant decrease in the means of total competence and problem scores over time, the improvement in activity scale, externalizing problem scores and post-traumatic stress disorder-related symptoms proved to be more significant in the foster care than in the orphanages. While the activity scale improved in the foster care, the school competence deteriorated in both samples, particularly among the girls in the orphanages. The improvement of boys' activity scores in the foster care, and deterioration of girls' school competence in the orphanages were the most significant gender differences between samples over time.
Even if the two orphan care systems showed more similarities than differences, the foster care revealed better outcomes over time. The results are discussed in relation to gender, age, socio-economic situation, cultural values and the characteristics of each care system.
Speech, for most of us, is a bimodal percept whenever we both hear the voice and see the lip movements of a speaker. Children who are born deaf never have this bimodal experience. We tested children who had been deaf from birth and who subsequently received cochlear implants for their ability to fuse the auditory information provided by their implants with visual information about lip movements for speech perception. For most of the children with implants (92%), perception was dominated by vision when visual and auditory speech information conflicted. For some, bimodal fusion was strong and consistent, demonstrating a remarkable plasticity in their ability to form auditory-visual associations despite the atypical stimulation provided by implants. The likelihood of consistent auditory-visual fusion declined with age at implant beyond 2.5 years, suggesting a sensitive period for bimodal integration in speech perception.
• auditory visual integration
• deafness
• learning
• sensitive periods
• speech development
This paper provides an overview of the largest longitudinal investigation of institutionalized children less than 2 years old ever conducted. The Bucharest Early Intervention Project is an ongoing randomized controlled trial of foster placement as an alternative to institutionalization in abandoned infants and toddlers being conducted in Bucharest, Romania. In addition to describing the contexts in which this study is imbedded, we also provide an overview of the sample, the measures, and the intervention. We hope that the natural experiment of institutionalization will allow us to examine directly the effects of intervention on early deprivation. We hope it will provide answers to many of the critical questions that developmentalists have asked about the effects of early experience, the timing of deprivation, and the ameliorating effects of early intervention and provide clues to which underlying neurobiological processes are compromised by, and resilient to, dramatic changes in early experience.
In a randomized controlled trial, we compared abandoned children reared in institutions to abandoned children placed in institutions but then moved to foster care. Young children living in institutions were randomly assigned to continued institutional care or to placement in foster care, and their cognitive development was tracked through 54 months of age. The cognitive outcome of children who remained in the institution was markedly below that of never-institutionalized children and children taken out of the institution and placed into foster care. The improved cognitive outcomes we observed at 42 and 54 months were most marked for the youngest children placed in foster care. These results point to the negative sequelae of early institutionalization, suggest a possible sensitive period in cognitive development, and underscore the advantages of family placements for young abandoned children.
This book attempts to trace the connection between the abandonment of orphanages and the rise of Aid to Families with Dependent Children
Objective
To examine attachment disturbances and disorder in a sample of children adopted into the U.K. following severe early privation and in a comparison sample of nondeprived, within-country, early-placed adoptees.
Ethological attachment theory is a landmark of 20th century social and behavioral sciences theory and research. This new paradigm for understanding primary relationships across the lifespan evolved from John Bowlby's critique of psychoanalytic drive theory and his own clinical observations, supplemented by his knowledge of fields as diverse as primate ethology, control systems theory, and cognitive psychology. By the time he had written the first volume of his classic Attachment and Loss trilogy, Mary D. Salter Ainsworth's naturalistic observations in Uganda and Baltimore, and her theoretical and descriptive insights about maternal care and the secure base phenomenon had become integral to attachment theory. Patterns of Attachment reports the methods and key results of Ainsworth's landmark Baltimore Longitudinal Study. Following upon her naturalistic home observations in Uganda, the Baltimore project yielded a wealth of enduring, benchmark results on the nature of the child's tie to its primary caregiver and the importance of early experience. It also addressed a wide range of conceptual and methodological issues common to many developmental and longitudinal projects, especially issues of age appropriate assessment, quantifying behavior, and comprehending individual differences. In addition, Ainsworth and her students broke new ground, clarifying and defining new concepts, demonstrating the value of the ethological methods and insights about behavior. Today, as we enter the fourth generation of attachment study, we have a rich and growing catalogue of behavioral and narrative approaches to measuring attachment from infancy to adulthood. Each of them has roots in the Strange Situation and the secure base concept presented in Patterns of Attachment. It inclusion in the Psychology Press Classic Editions series reflects Patterns of Attachment's continuing significance and insures its availability to new generations of students, researchers, and clinicians.
focuses on late developmental events [those occurring during the second trimester of gestation and continuing into the postnatal period]—synaptogenesis and synapse elimination—in human cerebral cortex [in fetuses–70 yr olds], and stresses functional correlates where these can be determined (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Utilizing the United Nations Convention on the Rights of the Child and the Guidelines for the Alternative Care of Children, this paper examines critical components and current characteristics of alternative care for children in low-resource countries. It begins by exploring the role of values within policy and practice related to child welfare. Then a brief examination comparing alternative care in high- versus low-resource countries is presented. Alternative care includes a continuum approach beginning with family support and reunification, kinship care, foster care, domestic adoption, and ending with intercountry adoption. Specific examples are provided from Eastern Europe, Latin America, and Africa. The paper concludes with the need for more research related to alternative care outcomes that could inform policy and practice.
The desire to scrutinize, understand and protect the child is a social development which has had enormous implications for the growth of all children, whether in or away from their own homes. The larger question raised in the present study is: are children with an institutional experience in infancy as well prepared for adjustment in foster homes as children with a continuous foster home experience? To answer this question, 40 children with continuous foster home experience were matched in terms of sex, age, age of admission to care, and years of dependency, with 40 foster home children whose infancy experience for about the first three years was in an infant institution. A study of the replacements of each of the children was made as the basis for evaluating the relative response of both groups to foster home placement. By replacement, reference is made to any transfer of a child from the foster home where he had been placed in the hope that he could secure long time or "permanent" care to another foster home. This tendency assumes practical significance for child care workers if one recognizes that, in a group of children with continuous foster home experience, deviant behavior or personality is of minimal significance as a reason for replacement. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Foster care is a societal intervention for orphaned, abandoned, and maltreated children. In the United States, more than 400,000 children are in foster care, and nearly half of those are younger than 5 years.1 These children are at substantially increased risk for psychopathology and account for a disproportionate share of public funding for psychiatric services, with spending perhaps 15 to 20 times as much as for low-income non-maltreated children.2 Although foster care has a social stigma, research clearly shows that high-quality foster care exists and is a far better alternative than other approaches to caring for abandoned or maltreated young children.3 Nevertheless, there is considerable room for improvement in “business as usual” foster care in the United States, and it is critical that improvements are implemented so that the needs of the youngest and most vulnerable children are met.
We are focusing in this article on a central problem of foster care, which is that it is often not developmentally informed. Our central thesis is that foster care for young children should be a different intervention than for older children. Decades of developmental research on the science of attachment should inform how we design and implement foster care for young children, with young children roughly defined here as younger than 6 years. If foster care is developmentally informed, then crucial features will be more intentionally pursued, as they can and should be. Colleagues in child protection and family courts make complex and difficult decisions daily, and as practitioners and researchers, we must ensure that they have and apply the best available information to inform these decisions.
Previous reports from the Bucharest Early Intervention Project suggested that children removed from institutions and placed into intervention displayed gains in IQ relative to children randomized to remain in institutional care.
The current report presents data from the 8-year follow-up of these children. One hundred and three of the original 136 children in the study were tested with the WISC IV.
Results reveal continued benefit from the intervention even though many of the children in both the intervention and control groups were no longer residing in their initial placements. Gains in IQ were particularly evident for those children who remained with their intervention family. There were also modest timing effects such that children placed earlier displayed higher scores on the WISC processing speed subscale. Early placement was also a significant predictor of a profile of stable, typical IQ scores over time.
These data suggest the continued importance of early intervention and the negative effects of severe psychosocial deprivation on the development of IQ scores across early childhood.
As any new parent knows, having a baby provides opportunities for enrichment, learning and stress - experiences known to change the adult brain. Yet surprisingly little is known about the effects of maternal experience, and even less about the effects of paternal experience, on neural circuitry not directly involved in parenting. Here we discuss how caregiving and the accompanying experiential and hormonal changes influence the hippocampus and prefrontal cortex, brain regions involved in cognition and mood regulation. A better understanding of how parenting impacts the brain is likely to help in devising strategies for treating parental depression, a condition that can have serious cognitive and mental health consequences for children.
This study examined classifications of attachment in 42-month-old Romanian children (N = 169). Institutionalized since birth, children were assessed comprehensively, randomly assigned to care as usual (CAU) or to foster care, and compared to family-reared children. Attachment classifications for children in foster care were markedly different from those in the CAU. Importantly, children placed in foster care before 24 months were more likely to have secure attachments and if placed earlier were less likely to have disorganized or insecure-other attachments. Cognitive status predicted greater likelihood of organized attachment in the CAU and greater likelihood of secure attachment in the foster care and never-institutionalized groups. Foster care is an important intervention to reduce the adverse effects following early deprivation.
The behavioral problems and affectional relationships of 26 children aged 4 1/2, continuously reared in institutions since early infancy, were compared with those of 30 working class children living at home. Thirty nine children of the same age who had been adopted from an institution or restored to their mothers between the ages of 2 and 4 were also studied. The institutional children had different, but no more frequent problems than the working class children; the adopted children had significantly fewer problems than the institutional children. A minority of the institutional and ex institutional children were 'over friendly' to strangers and indiscriminately affectionate; most of the adopted but few of the institutional children were believed to have formed close attachments to adults.
In the neocortex, the onset of the rapid phase (phase 3) of synaptogenesis occurs after the end of neurogenesis. However, we still do not know whether or not these two developmental events are causally related. The present study compares the time-course and tempo of neurogenesis and synaptogenesis in the anterior cingulate cortex (area 24 of Brodmann) and in the primary visual cortex (area 17) in a series of pre- and postnatal rhesus monkeys. Autoradiographic analysis of animals fetally injected with 3H-thymidine showed that all neurons destined for area 24 are generated by embryonic day 70, which is 30 days earlier than in area 17. The rapid phase of synaptogenesis in area 24 starts during the third embryonic month and continues at the same rate through the remainder of gestation and the first 2 months after birth, as has been seen in neocortical areas examined previously. Statistical analysis of the linear portions of the rapid phase indicates that, although neurogenesis in area 24 is completed 1 month earlier than in area 17, the rapid phase of synaptogenesis occurs 41 days later. Moreover, the tempo of synaptic accretion was remarkably similar to that in motor, somatosensory, visual, or associational areas. All were grouped within the same time window of about 40 days, centered at birth. After the second postnatal month, synaptic density in area 24 remains at a high level until sexual maturity. This work shows that the rapid phase of synaptogenesis in the cingulate mesocortex is not linked temporally to the end of neurogenesis. We suggest that it is regulated by the same genetic or humoral factors that control synaptogenesis in the phylogenetically newer neocortical areas.
Attachment and indiscriminately friendly behavior were assessed in children who had spent at least 8 months in a Romanian orphanage (RO) and two comparison groups of children: a Canadian-born, nonadopted, never institutionalized comparison group (CB) and an early adopted comparison group adopted from Romania before the age of 4 months (EA). Attachment was assessed using 2 measures: an attachment security questionnaire based on parent report, and a Separation Reunion procedure that was coded using the Preschool Assessment of Attachment. Indiscriminately friendly behavior was examined using parents' responses to 5 questions about their children's behavior with new adults. Although RO children did not score differently from either CB or EA children on the attachment security measure based on parent report, they did display significantly more insecure attachment patterns than did children in the other 2 groups. In addition, RO children displayed significantly more indiscriminately friendly behavior than both CB and EA children, who did not differ in terms of indiscriminate friendliness. RO children's insecure attachment patterns were not associated with any aspect of their institutional environment, but were related to particular child and family characteristics. Specifically, insecure RO children had more behavior problems, scored lower on the Stanford-Binet Intelligence Scale, and had parents who reported significantly more parenting stress than RO children classified as secure.
Previous research has shown that children receiving substitute parental care tend to have high rates of emotional/behavioural disturbance, but uncertainty remains on the extent to which this derives from genetic risk, adverse experiences before receiving substitute care, or from risks associated with substitute care experiences. In order to examine the effects of institutional rearing (as a specific form of substitute care), two groups of primary school children reared in substitute care from before the age of 12 months were compared: 19 children in residential group (institutional) care and 19 in continuous stable foster family care (matched for age and gender). The two groups were similar in coming from biological families with high rates of psychopathology and social malfunctioning, but differed with respect to pattern of rearing. Both groups were compared with classroom controls, using teacher questionnaires, systematic classroom observations, and standardised cognitive testing. Parental questionnaires were also obtained for the two substitute care groups. As found previously, the combined substitute care groups differed from controls in showing a high level of hyperactivity/inattention. The observational measures showed a similar effect, indicating that the elevated rate was not attributable to rater bias. The teacher questionnaire and observational measures showed, however, that the increased level of hyperactivity/ inattention was substantially higher in the institutional group than the foster family group. Parental questionnaire ratings showed the same contrast between the groups, except that the main difference was on unsociability and emotional disturbance rather than hyperactivity/ inattention. It is concluded that, against a background of genetic and early environmental risk, institutional rearing predisposes to a pattern of hyperactivity/inattention.
n deciding if a treatment is likely to work in an individ- ual patient, clinicians need to know the effect of the in- tervention in patients who take the treatment as pre- scribed. However, participants in clinical trials may not adhere to the protocol, or clinicians may recommend with- drawal of the study medication because of apparent adverse effects. Should investigators exclude from the analysis any participants who violate the research protocol? In this article, we review how randomization reduces bias in clinical trials and then discuss the importance of including all eligible pa- tients in the analysis, to ensure the validity of the results. Preventing bias in randomized controlled trials The randomized controlled clinical trial is the best way to minimize bias in ascertaining treatment effects. The in- tent of randomization is to establish groups of patients with similar distributions of the characteristics that could deter- mine whether they will suffer the adverse outcome of inter- est. If prognostic factors are balanced in the 2 (or more) groups and if the treatment has no effect, the proportion of participants experiencing the target outcome will be similar in the arms of the study. Conversely, if differences in out- come are observed, clinicians can confidently attribute those differences to the experimental intervention. Applying the intention-to-treat principle How should investigators analyze study data if one or more patients have not adhered to the allocated manage- ment strategy, for whatever reason? Some investigators deal with these protocol violations by excluding the participants from the analysis. This form of analysis, known as a per pro- tocol, efficacy, explanatory analysis, or analysis by treatment administered, describes the outcomes of the participants who adhered to the research protocol. Although investiga- tors can use information from such an analysis to estimate the intervention's efficacy in those who actually received it in the intended intensity or dose for the intended interval, this estimate is likely to be seriously flawed. The problem arises because the reasons for nonadher- ence to the protocol may be related to prognosis. Empirical evidence suggests that participants who adhere tend to do better than those who do not adhere, even after adjustment for all known prognostic factors and irrespective of assign- ment to active treatment or placebo.
To determine whether signs of disordered attachment were greater in young children being reared in more socially depriving caregiving environments.
Three groups of children were studied by means of structured interviews with caregivers that were administered over several months in Bucharest, Romania, in 1999: (1) 32 toddlers living in a typical unit (standard care) in a large institution in Bucharest; (2) 29 toddlers living in the same institution on a 'pilot unit" designed to reduce the number of adults caring for each child; and (3) 33 toddlers living at home who had never been institutionalized. The presence of attachment disorders and other behavioral problems was assessed by caregiver/ parent report.
Children on the typical unit (standard care) had significantly more signs of disordered attachment than children in the other two groups. Both the emotionally withdrawn and the indiscriminately social pattern of attachment disorder were apparent in these children, but cluster analysis suggested that mixed patterns are more typical.
The continuum of caretaking casualty is reflected by increasing signs of disordered attachment in toddlers living in more socially depriving environments.
Child-parent attachment quality with an adoptive caregiver at age 4 years was examined in a sample of 111 children adopted into the United Kingdom following early severe deprivation in Romania and a comparison group of 52 nondeprived within-United Kingdom adoptees. Findings indicated that, compared with nondeprived adoptees, children who experienced early severe deprivation were less likely to be securely attached and more likely to show atypical patterns of attachment behavior; ordinary forms of insecure attachment were not associated with deprivation. Within the sample of deprived adoptees, there was a dose-response association between duration of deprivation and disturbances in attachment behavior. In addition, a minority of children who experienced severe early deprivation were classified as avoidant, secure, or dependent using conventional classification strategies, despite also exhibiting atypical patterns of attachment behaviors, and this was also more likely among children exposed to prolonged deprivation. The results raise both theoretical and methodological implications for attachment research on very deprived children.
This study examined attachment in institutionalized and community children 12-31 months of age in Bucharest, Romania. Attachment was assessed using ratings of attachment behaviors and ratings of caregiver descriptions in a structured interview. As predicted, children raised in institutions exhibited serious disturbances of attachment as assessed by all methods. Observed quality of caregiving was related to formation and organization of attachment in children living in institutions. These results held even when other variables, such as cognitive level, perceived competence, and quantitative interaction ratings, were controlled for. Ratings of attachment behavior in the Strange Situation and caregiver reports of signs of Reactive Attachment Disorder converged moderately. The implications of these findings for different perspectives on attachment are discussed.
We assess individual differences in the caregiving environments of young children being raised in institutions in Romania in relation to developmental characteristics such as physical growth, cognitive development, emotional expression, and problem and competence behaviors.
Videotaped observations of the child and favorite caregiver in their 'home' environment were coded for caregiving quality, and this was related to child characteristics. Child emotional reactivity was assessed during responses to interactional tasks. Cognitive development was assessed from child responses to the Bayley Scales of Infant Development. Data regarding problem behaviors and competence were obtained from caregiver report. Children reared in institutions were compared on all of these measures to never institutionalized children to assist gauging degree of impairment.
Children raised in institutions demonstrated marked delays in cognitive development, poorer physical growth, and marked deficits in competence. Individual differences in caregiving environment were associated with cognitive development, competence, and negative behavior among these young children being reared in institutions.
These data confirm previous findings regarding deficits associated with institutional care and extend our understanding of the impact of individual differences in caregiving quality on the development of young children in institutions.
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