INDISCRIMINATE BEHAVIOR OBSERVED IN THE STRANGE SITUATION AMONG INSTITUTIONALIZED TODDLERS: RELATIONS TO CAREGIVER REPORT AND TO EARLY FAMILY RISK

Social competencies of children with disinhibited social engagement disorder: A systematic review

Background

Children with Disinhibited Social Engagement Disorder (DSED) have specific difficulties with indiscriminate sociability, yet little is known about their broader social competencies as DSED tends not to be identified within samples in the wider 'maltreatment literature.'

Aim

To systematically review the literature to determine the social competencies of children with DSED.

Methods

A comprehensive search following PRISMA guidelines was undertaken using PsycINFO, Medline, Embase, and Cumulative Index to Nursing & Allied Health.

Results

From a total of 553 articles, 16 studies were selected and critically evaluated. Children with DSED were consistently reported to have poorer social competencies than non-maltreated peers and environmental controls. Greater peer problems were consistently found, and they may present with poor self-esteem/concept related to social acceptance. Findings regarding social interaction/communication skills were mixed.

Limitations

50% of studies were of moderate quality due to sampling and possible confounding variables.

Conclusion

Children with DSED present with social relationship problems, beyond the core symptoms of the disorder, but the relative impact of co-occurring neurodevelopmental conditions is not yet clear. In addition, pragmatic language and communication skills require further research.

Predictors of the rate and course of reactive attachment disorder and disinhibited social engagement disorder symptoms in foster children during the first year of placement

BACKGROUND

Due to adverse care experiences, foster children are at risk for developing symptoms of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED).

OBJECTIVE

This study investigated the factors influencing rate and course of RAD and DSED symptoms during the first year of placement in long-term foster care.

PARTICIPANTS AND SETTING

The sample consisted of 55 foster children aged 1 to 6 years. Measurements were taken at placement as well as 6 and 12 months after placement.

METHODS

RAD and DSED symptoms were assessed with the Disturbance of Attachment Interview (DAI). DSED symptoms were also assessed by observation with the Rating of Infant Stranger Engagement (RISE). Foster parents and caseworkers reported on children's preplacement experiences and placement characteristics.

RESULTS

RAD symptoms were rare at Wave 1 (5.5 %) and remitted in most children within the first six months of placement, t(54) = 3.06, p = .003. A total of 30.9 % of the foster children presented DSED symptoms according to the DAI, but only 5.5 % of the children according to the RISE. Foster parents reported symptom reduction, t(54) = 3.71, p = .003, while observational data indicated symptom stability. Prior placement in emergency foster care was associated with lower levels of RAD at Wave 1, F(1.62, 80.88) = 7.80, p = .002, while later placed children presented more RAD and DSED symptoms (RRAD2 = 0.07, RDSED2 = 0.08, RRISE2 = 0.12). Psychopathology of the biological parents (RRAD2 = 0.07, RDSED2 = 0.08) and visitation with the biological parents (RRISE2 = 0.14) predicted symptom stability.

CONCLUSION

A substantial number of foster children present persistent DSED symptoms indicating a need for evidenced based interventions.

Review of the Current Knowledge of Reactive Attachment Disorder

Reactive attachment disorder (RAD), classified under Trauma and Stressor Related Disorders in the DSM-5 manual, is a childhood psychiatric illness due to familial or social neglect or due to maltreatment. It is characterized by an inhibited and withdrawn social and emotional behavior toward an adult caregiver, typically before the age of 5. Neurobiological changes in patients with RAD have been shown to be substantially significant with features such as loss of grey matter volume and neurotransmitter deficiencies that not only impact the ability to form healthy attachments but also increase the risk of comorbidities such as depression and anxiety. Different theories, including the current mediation hypothesis and learning theory of attachment, showed childhood maltreatment from caregivers and desensitization toward deficiencies in social development in children from special education teachers to be key components in the development of RAD. Patients with RAD had an increased risk of developing psychiatric comorbidities, including learning disabilities and mood disorders. Institutionalized care and childhood maltreatment have a significant impact on the development of RAD. RAD is an underdiagnosed and underreported condition with significant repercussions that can severely impact the development of a child. By being able to raise awareness and promote further research into refining the diagnostic methodology, treatment protocols, and long-term follow-up, children afflicted with this condition may be able to develop better socio-emotional bonds and reduce the incidence of comorbidities such as depression and attention deficit hyperactivity disorder.

Explaining the accumulation of victimization in vulnerable children: Interpersonal violence among children traumatized by war and disaster in a children's home in Sri Lanka

Research in postconflict settings indicated that children's exposure to war and natural disaster is a significant predictor of experiencing violence within their families. However, it is unclear if this effect is driven by characteristics of traumatized children or their parents. To disentangle these different factors we conducted a survey in a children's home in Sri Lanka. A total of 146 institutionalized children (aged 8 to 17) were interviewed using standardized questionnaires administered by local senior counselors in order to assess children's exposure to mass trauma, family violence, and violence in the institution as well as their mental health. Linear regression analyses revealed that, controlling for potential confounds, previous exposure to civil war was a significant predictor of violence by guardians in the children's home. In addition, previous exposure to family violence was a significant predictor of violence by peers in the institutions. A mediation analysis showed that children's internalizing and externalizing behavior problems partly mediated the relationship between violence prior to the admission to the children's home and violence in the children's home. The findings of our study provide evidence for the assumption that the transmission of mass trauma into interpersonal violence can occur independently from parents through children's psychopathology.

Disinhibited social engagement behaviors in young maltreated children: Dysfunctional behavior of biological parents and child attachment

BACKGROUND

Studies on children with disinhibited social engagement behavior (DSEB) and their caregivers have primarily been limited to institution-reared children.

OBJECTIVE

Using a sample of intact parent-child dyads, the current study examined the distinct contributions of dysfunctional (disconnected/extremely insensitive) parental behaviors and type of maltreatment on maltreated children's levels of DSEB. Child time in foster care and quality of attachment to caregiver were taken in account.

PARTICIPANTS

The sample comprised 67 children (1-5 years old) and their biological parent with substantiated maltreatment and recruited through child protective services between the years of 2008 and 2012.

METHODS

Observations of parent-child interactions were collected and child CPS files were consulted.

RESULTS

Results indicate that very few children (4%), in this predominantly neglected sample (79 %), showed high levels of DSEB. Levels of socioeconomic risks, child age, child sex, time in placement, or attachment to caregiver were not significantly related to DSEB. The vast majority of the children developed an insecure attachment to their parent (76 %), especially of the disorganized type (51 %). Finally, beyond neglect, which was no longer associated with DSEB in the final model, we found that the more the parent showed disconnected and extremely insensitive behavior (R² = .10), in particular withdrawn behavior, the more the children exhibited DSEB.

CONCLUSION

Albeit of a small magnitude, we suggest that the quality of parental behavior could play a role in children's development and recovery of DSEB.

Development and Examination of the Reactive Attachment Disorder and Disinhibited Social Engagement Disorder Assessment Interview

The fifth edition of the Diagnostic and Statistical Manual (DSM) categorizes reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) as two separate disorders, and their criteria are revised. For DSED, the core symptoms focus on abnormal social disinhibition, and symptoms regarding lack of selective attachment have been removed. The core symptoms of RAD are the absence of attachment behaviors and emotional dysregulation. In this study, an international team of researchers modified the Child and Adolescent Psychiatric Assessment for RAD to update it from DSM-IV to DSM-5 criteria for RAD and DSED. We renamed the interview the reactive attachment disorder and disinhibited social engagement disorder assessment (RADA). Foster parents of 320 young people aged 11 to 17 years completed the RADA online. Confirmatory factor analysis of RADA items identified good fit for a three-factor model, with one factor comprising DSED items (indiscriminate behaviors with strangers) and two factors comprising RAD items (RAD1: failure to seek/accept comfort, and RAD2: withdrawal/hypervigilance). The three factors showed differential associations with clinical symptoms of emotional and social impairment. Time in foster care was not associated with scores on RAD1, RAD2, or DSED. Higher age was associated with lower scores on DSED, and higher scores on RAD1.

Disinhibited attachment behavior among infants of mothers with borderline personality disorder, depression, and no diagnosis

Disinhibited attachment behavior is related to early institutional rearing and to later social maladaptation. It is also seen among infants reared at home whose mothers have histories of child maltreatment or psychiatric hospitalization. However, little is known about the maternal psychiatric diagnoses that might be associated with disinhibited behavior or the mechanisms through which maternal diagnosis might influence infant behavior. In the current study (N = 59), 2 maternal diagnoses, borderline personality disorder (BPD; n = 13) and depression (n = 15), were compared with a no diagnosis group (n = 31) on extent of infant disinhibited behavior. Disinhibited infant behavior was assessed at infant age of 12-18 months using the validated Rating of Infant-Stranger Engagement. Mother-infant interaction was coded using the Atypical Maternal Behavior Instrument for Assessment and Classification. Results indicated that infants of mothers with BPD were significantly more likely to be rated as disinhibited in their behavior toward the stranger compared with infants of mothers with depression and with no diagnosis. Disinhibited behavior was further related to the quality of mother-infant interaction, and maternal frightened/disoriented interaction partially mediated the effect of maternal BPD on infant disinhibited behavior. Disinhibited behavior among previously institutionally reared infants is relatively resistant to intervention after toddlerhood and is associated with maladaptation into adolescence. Therefore, high priority should be placed on understanding the developmental trajectories of home-reared infants with disinhibited behavior and on providing early assessment and early parenting support to mothers with BPD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

EARLY MALTREATMENT AND CURRENT QUALITY OF RELATIONAL CARE PREDICT SOCIOEMOTIONAL PROBLEMS AMONG INSTITUTIONALIZED INFANTS AND TODDLERS

The present study is focused on child socioemotional problems 6 months after institutionalization, by considering the putative predictive role of child maltreatment, of developmental functioning at admission and the following months, and of the quality of institutional relational care. Fifty institutionalized infants and toddlers participated in this study. Child developmental functioning (i.e., cognitive, language, and motor development) was assessed at admission to the institution (Wave 0), and 3 (Wave 1) and 6 months (Wave 2) thereafter. The quality of institutional relational care-operationalized in terms of caregivers' sensitivity and cooperation-was measured at Wave 2. Caregivers reported on the presence of disturbed socioemotional behaviors at Wave 2. Child gestational age, birth weight, age, and stunted growth at admission to the institution served as covariates. Results revealed significant associations between socioemotional difficulties and lower levels of motor development at Waves 0 and 1, child maltreatment, and less sensitive caregiving. A logistic regression showed that child maltreatment and caregiver insensitivity were the only significant predictors of disturbed socioemotional functioning by the end of 6 months of institutionalization.

[Symptoms of Attachment Disorder, Behavioral Regulation and Physiological Stress in Institutionalized Children]

Symptoms of Attachment Disorder, Behavioral Regulation and Physiological Stress in Institutionalized Children The aim of the study was to investigate the influence of attachment status (availability of a specific caregiver) and caregiving quality on behavioral and physiological adaptation and attachment disorder in institutionalized children. In a sample of children from a Georgian children's home, attachment disorder symptoms were assessed by interview and attachment and exploration behavior as well as self-regulatory behavior were assessed by observation in the natural group setting as well in structured dyadic situations. The child circadian cortisol level was determined to assess physiological adaption. Quality of caregiving was assessed in terms of sensitivity by observation. While attachment status affected the occurrence of attachment disorder symptoms and physiological stress, patterns of regulation in terms of attachment-exploration-balance and self-regulatory behavior were predicted by caregiver sensitivity.

Assessment of attachment disorder symptoms in foster children: comparing diagnostic assessment tools

BACKGROUND

Standardized methods for assessing attachment disorders are scarce but needed for research and practice.

METHODS

In the current study, several assessments for attachment disorder symptoms are used within a German sample of foster children after being exposed to neglect and maltreatment in their biological families. The symptoms were assessed with four established assessment methods based on both parents' report and behavioral observation: The Rating for Infant Stranger Engagement, the Stranger at the Door, the Disturbances of Attachment Interview and the Reactive Attachment Disorder Questionnaire.

RESULTS

The foster care sample showed symptoms of both the inhibited and the disinhibited attachment disorder. The degree of symptoms is comparable to previous findings. The results of the different tools investigating the disinhibited type of attachment disorder are correlated to each other, but do not overlap.

CONCLUSIONS

Although all approaches are based on the clinical criteria of the DSM-IV, the assessments do not coincide. Each tool provides a different point of view on the symptoms, so a multi methodical approach for assessing attachment disorder symptoms should be implemented. Furthermore, the inhibited and the disinhibited symptoms represent separate categories, as reflected in the DSM-5, requiring separate assessment.

CAREGIVER SENSITIVITY AND CONSISTENCY AND CHILDREN'S PRIOR FAMILY EXPERIENCE AS CONTEXTS FOR EARLY DEVELOPMENT WITHIN INSTITUTIONS

The current study addressed whether two institution-wide interventions in St. Petersburg, Russian Federation, that increased caregiver sensitivity (Training Only: TO) or both caregiver sensitivity and consistency (Training plus Structural Changes: T+SC) promoted better socioemotional and cognitive development than did a No Intervention (NoI) institution during the first year of life for children who were placed soon after birth. It also assessed whether having spent less than 9 versus 9 to 36 months with a family prior to institutionalization was related to children's subsequent socioemotional and cognitive development within these three institutions. The Battelle Developmental Inventory (J. Newborg, J.R. Stock, L. Wnek, J. Guidubaldi, & J. Svinicki, 1988) was used to assess the socioemotional and cognitive functioning of children in NoI (n = 95), TO (n = 104), and T+SC (n = 86) at two to three time points during their first 6 to 12 months of residency. Results suggest that improving caregiver sensitivity can improve the cognitive development of infants in the first year of institutionalization whereas improving caregiver consistency in addition to sensitivity is more beneficial for socioemotional development than is sensitivity alone. Similarly, for children in T+SC, longer time with a family prior to institutionalization (consistent caregiver, unknown sensitivity) was associated with better socioemotional, but not cognitive, baseline scores and more rapid cognitive than socioemotional development during institutionalization. These results suggest caregiver sensitivity is more highly related to cognitive development whereas caregiver consistency is more related to socioemotional development in the first years of life.

Fostering Child Development by Improving Care Quality: A Systematic Review of the Effectiveness of Structural Interventions and Caregiver Trainings in Institutional Care

Quality of child care has been shown to have a crucial impact on children's development and psychological adjustment, particularly for orphans with a history of maltreatment and trauma. However, adequate care for orphans is often impacted by unfavorable caregiver-child ratios and poorly trained, overburdened personnel, especially in institutional care in countries with limited resources and large numbers of orphans. This systematic review investigated the effects of structural interventions and caregiver trainings on child development in institutional environments. The 24 intervention studies included in this systematic review reported beneficial effects on the children's emotional, social, and cognitive development. Yet, few studies focused on effects of interventions on the child-caregiver relationship or the general institutional environment. Moreover, our review revealed that interventions aimed at improving institutional care settings have largely neglected violence and abuse prevention. Unfortunately, our findings are partially limited by constraints of study design and methodology. In sum, this systematic review sheds light on obstacles and possibilities for the improvement in institutional care. There must be greater efforts at preventing violence, abuse, and neglect of children living in institutional care. Therefore, we advocate for combining attachment theory-based models with maltreatment prevention approaches and then testing them using rigorous scientific standards. By using approaches grounded in the evidence, it could be possible to enable more children to grow up in supportive and nonviolent environments.

Convergence between observations and interviews in clinical diagnosis of reactive attachment disorder and disinhibited social engagement disorder

OBJECTIVE

A comprehensive approach is needed for diagnosing disordered attachment behavior due to the multifaceted nature of attachment. Differences between various indicators can pose a challenge for deciding on the proper diagnosis. This study assessed the convergence between clinical interview assessment and observation-based clinical diagnosis, and their linkages with inadequate care.

METHOD

Participating children ( N = 55) had intelligence quotients (IQs) between 50 and 85 and were referred for psychiatric consultation. Data were obtained by structured review of medical records, the Disturbances of Attachment Interview (DAI), and the Clinical Observation of Attachment (COA) procedure.

RESULTS

Of the 18 children identified using the DAI with Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) diagnosis of reactive attachment disorder (RAD) and/or disinhibited social engagement disorder (DSED), only 7 received a clinical DSM-5 diagnosis of RAD and/or DSED. Observed maladaptive attachment behavior in the COA was strongly associated with DAI scores and with clinical diagnosis of DSM-5 RAD and/or DSED. There was a significantly higher prevalence of extremes of insufficient care in children who were classified with RAD by DAI or DSM-5 and/or with DSED by DSM-5 compared to those with no attachment disorder.

CONCLUSIONS

Using structured observation and record assessment leads to more conservative identification of RAD or DSED than using the DAI.

Inhibited attachment disordered behavior in institutionalized preschool children: links with early and current relational experiences

Inhibited attachment disordered behavior (IADB) is characterized by difficulty in establishing an attachment relationship with a primary caregiver; is associated with persistent social and emotional problems; and is observed most frequently in contexts of pathological care such as institutional rearing. Here, we seek to enhance understanding of the conditions that give rise to IADB among institutionalized children by examining prior family experiences of neglect and deprivation and concurrent relational experiences at the institution. The sample is comprised of 146 children, between 36 and 78 months. IADB was assessed using a semi-structured interview administered to the child's primary caregiver. Results revealed that both pre-institutionalization experiences (e.g. parental abandonment) and current relational ones (e.g. low quality of child-caregiver relationship) predicted IADB. Findings are discussed in light of the need to promote conditions which foster the establishment and maintenance of the child's selective attachment to a caregiving figure.

Culturally sensitive adaptation of the concept of relational communication therapy as a support to language development: An exploratory study in collaboration with a Tanzanian orphanage

BACKGROUND

Orphans and other vulnerable children (OVC) who grow up in institutional care often show communication and language problems. The caregivers lack training, and there are few language didactics programmes aimed at supporting communication and language development in OVC in institutional care in Tanzania.

OBJECTIVES

The purpose of the study was to adapt the German concept of relational communication therapy (RCT) as a support to language development in a Tanzanian early childhood education context in a culturally sensitive way. Following the adaptation of the concept, a training programme for Tanzanian caregiver students was developed to compare their competencies in language didactics before and after training.

METHODS

A convergent mixed methods design was used to examine changes following training in 12 participating caregiver students in a Tanzanian orphanage. The competencies in relational language didactics were assessed by a self-developed test and video recordings before and after intervention. Based on the results, we drew conclusions regarding necessary modifications to the training modules and to the concept of RCT.

RESULTS

The relational didactics competencies of the caregiver students improved significantly following their training. A detailed analysis of the four training modules showed that the improvement in relational didactics competencies varied depending on the topic and the teacher.

CONCLUSION

The results provide essential hints for the professionalisation of caregivers and for using the concept of RCT for OVC in institutional care in Tanzania. Training programmes and concepts should not just be transferred across different cultures, disciplines and settings; they must be adapted to the specific cultural setting.

The course of early disinhibited social engagement among post-institutionalized adopted children

BACKGROUND

Approximately 20% of post-institutionalized (PI) children exhibit disinhibited social engagement (DSE) or the propensity to approach and engage strangers. There is little longitudinal research examining changes in DSE after adoption, or methods of identifying children with persistent behaviors.

METHODS

DSE was assessed observationally four times during the first 2 years postadoption in PI children 16-36 months at adoption (n = 68) relative to same-age nonadopted children (n = 52). At age 5, a validated interview determined which PI children met criteria for Disinhibited Social Engagement Disorder (DSED).

RESULTS

DSE trajectories initially increased and then stabilized. PIs had higher DSE levels initially and a steeper increase rate than NAs. When separated into physical and nonphysical DSE components, group differences arose in initial physical DSE and the rate of change of nonphysical DSE. DSE rate of increase predicted DSED diagnosis, as did longer institutional duration and poorer institutional care.

CONCLUSIONS

The rate of increase in DSE postadoption, rather than the level observed at adoption, is predictive of disordered social engagement by age 5 years.

Trauma- and Stressor-Related Disorders Among Children and Adolescents

DSM-5 introduced a clustering of disorders designated "trauma- and stressor-related disorders." These disorders are unique in that the etiology is specified as part of the diagnostic criteria. In this review, the authors consider how some of these disorders manifest for children and adolescents. In posttraumatic stress disorder and related disorders, the child is exposed to one or more frightening, traumatic events. In attachment disorders, the child experiences severe social neglect. With this framework in mind, the authors consider details of several prominent trauma- and stressor-related disorders that arise in response to either excessive, unwanted input or inadequate, necessary input among children and adolescents.

Annual research review: Attachment disorders in early childhood--clinical presentation, causes, correlates, and treatment

BACKGROUND

Though noted in the clinical literature for more than 50 years, attachment disorders have been studied systematically only recently. In part because of the ubiquity of attachments in humans, determining when aberrant behavior is best explained as an attachment disorder as opposed to insecure attachment has led to some confusion. In this selective review, we consider the literature on reactive attachment disorder and disinhibited social engagement disorder and describe an emerging consensus about a number of issues, while also noting some areas of controversy and others where we lack clear answers. We include a brief history of the classification of the disorders, as well as measurement issues. We describe their clinical presentation, causes and vulnerability factors, and clinical correlates, including the relation of disorders to secure and insecure attachment classifications. We also review what little is known and what more we need to learn about interventions.

METHODS

We conducted a literature search using PubMed, PsycINFO, and Cochrane Library databases, using search terms 'reactive attachment disorder,' 'attachment disorder,' 'indiscriminate behavior,' 'indiscriminate friendliness,' 'indiscriminate socially disinhibited reactive attachment disorder,' 'disinhibited social engagement disorder,' and 'disinhibited social behavior.' We also contacted investigators who have published on these topics.

FINDINGS

A growing literature has assessed behaviors in children who have experienced various types of adverse caregiving environments reflecting signs of putative attachment disorders, though fewer studies have investigated categorically defined attachment disorders. The evidence for two separate disorders is considerable, with reactive attachment disorder indicating children who lack attachments despite the developmental capacity to form them, and disinhibited social engagement disorder indicating children who lack developmentally appropriate reticence with unfamiliar adults and who violate socially sanctioned boundaries.

CONCLUSIONS

Although many questions remain to be answered, especially regarding appropriate interventions, we know considerably more about attachment disorders than we did only a decade ago.

Indiscriminate behaviors in previously institutionalized young children

OBJECTIVE

This study included 54-month-old children with a history of institutional care. Our goal was to: (1) examine differences in indiscriminate social behaviors in children with a history of institutional care compared with home-reared children; (2) test whether foster care reduces indiscriminate social behaviors in a randomized controlled trial; and (3) examine early predictors of indiscriminate behaviors.

METHODS

Participants were 58 children with a history of institutional care and 31 never-institutionalized control (NIG) subjects enrolled in a randomized controlled trial of foster care for institutional care, assessed from toddlerhood to 54 months. Indiscriminate social behaviors were measured naturalistically by using the Stranger at the Door procedure.

RESULTS

In the Stranger at the Door procedure, children with a history of institutional care left with a stranger at higher rates than NIG subjects (33% vs. 3.5%; P < .001). Children in the care as usual group left more than NIG subjects (41.9% vs. 3.6%; P ≤ .001). The differences between the foster care group (24.1%) and the care as usual group and between foster care group and NIG were not significant. In a logistic regression, early disorganized attachment behaviors, baseline developmental quotient, and caregiving quality after randomization contributed to variance at 54 months. In the same analysis using only children with a history of institutional care, only disorganized attachment contributed significantly to 54-month indiscriminate social behaviors (Exp[B] = 1.6 [95% confidence interval: 1.1-2.5]).

CONCLUSIONS

Observed socially indiscriminate behaviors at 54 months were associated with prolonged exposure to institutional care. Young children raised in conditions of deprivation who fail to develop organized attachments as toddlers are at increased risk for subsequent indiscriminate behaviors.

Does early family risk and current quality of care predict indiscriminate social behavior in institutionalized Portuguese children?

The current study extends research on the effects of institutionalization, most notably by evaluating the influence of proximal relationship processes over and above prenatal and pre-institutional family experiences. By focusing on current quality of institutional care and the child's early family background, it examines the influence of variations in the institutionalization experience on displays of indiscriminate social behavior, after taking into account potentially confounding pre-admission experiences. Seventy-four Portuguese children (11-30 months) placed in 17 residential institutions and their primary caregivers participated in the study. Children's displays of indiscriminate social behavior were assessed based on an observational measure and a semi-structured interview administered to the child's caregiver. Data on children's physical and mental development were also collected. Three contextual-risk composites of early family behavior - prenatal, family relational, and emotional-neglect--were created. The quality of institutional care was examined in terms of structural, relational characteristics, and, additionally, of the quality of child-caregiver relationship. Current quality of care experienced in the institution, operationalized in terms of the absence (vs. presence) of a preferred caregiver, predicted indiscriminate social behavior over and above prenatal and family risk conditions that preceded the child's institutionalization.

Age at adoption from institutional care as a window into the lasting effects of early experiences

One of the major questions of human development is how early experience impacts the course of development years later. Children adopted from institutional care experience varying levels of deprivation in their early life followed by qualitatively better care in an adoptive home, providing a unique opportunity to study the lasting effects of early deprivation and its timing. The effects of age at adoption from institutional care are discussed for multiple domains of social and behavioral development within the context of several prominent developmental hypotheses about the effects of early deprivation (cumulative effects, experience-expectant developmental programming, and experience-adaptive developmental programming). Age at adoption effects are detected in a majority of studies, particularly when children experienced global deprivation and were assessed in adolescence. For most outcomes, institutionalization beyond a certain age is associated with a step-like increase in risk for lasting social and behavioral problems, with the step occurring at an earlier age for children who experienced more severe levels of deprivation. Findings are discussed in terms of their concordance and discordance with our current hypotheses, and speculative explanations for the findings are offered.

Diverse physical growth trajectories in institutionalized Portuguese children below age 3: relation to child, family, and institutional factors

OBJECTIVE

To identify and analyze diverse longitudinal trajectories of physical growth of institutionalized children and their relation to child, family, and institutional factors.

METHODS

49 institutionalized children were studied for 9 months after admission. Weight, height, and head circumference were measured on 4 occasions, beginning at admission. Data were analyzed using latent class analysis, yielding diverse patterns of growth for each feature, and relations with child characteristics, early family risk factors, and institutional relational care were investigated.

RESULTS

For each growth feature, 4 classes emerged: "Persistently Low," "Improving," "Deteriorating," and "Persistently High." Younger age at admission was a risk factor for impaired physical growth across all domains. Physical characteristics at birth were associated with trajectories across all domains. Lower prenatal risk and better institutional relational care were associated with Improving weight over time.

CONCLUSIONS

Discussion highlights the role of children's physical features at birth, prenatal risk, and caregiver's cooperation with the child in explaining differential trajectories.