The Course of Inattention and Hyperactivity/Impulsivity Symptoms After Foster Placement

Mount Sinai Adolescent Health Center, Department of Pediatrics, 320 E 94th St, New York, NY 10128, USA.
PEDIATRICS (Impact Factor: 5.47). 03/2010; 125(3):e489-98. DOI: 10.1542/peds.2009-1285
Source: PubMed


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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    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.
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