Measurement of Behavioral and Emotional Outcomes of Youth in Foster Care: Investigation of the Roles of Age and Placement Type

Perceived social support: Measurement differences in youth residing in the community versus youth residing in foster care

BACKGROUND

Social support is commonly examined as a protective factor for children with a history of child maltreatment, and it has been measured by self-report via the Social Support Scale for Children (SSSC). Although the SSSC has established adequate reliability and validity in community and clinical samples, its psychometric properties have yet to be assessed in a sample of foster care youth.

OBJECTIVE

This study provided a psychometric comparison of the SSSC in youth residing in foster care with youth residing in the community.

PARTICIPANTS AND SETTING

Participants were two, comparable samples of 214 youth participants residing in foster care and 163 youth participants from the community between the ages of 8-12 years.

METHODS

Community participants were recruited from local middle schools, and an age-matched comparison sample from a larger study on youth in foster care was utilized for comparison. Youth self-reported across measures and provided demographic information. Confirmatory factor analysis was utilized to determine measurement model fit to the data, and invariance testing was conducted to compare measurement models across the samples.

RESULTS

Differences between samples in the factor structure and item distribution of the SSSC emerged. Specifically, the community sample provided adequate fit to the original four-factor model (friend, classmate, teacher, parent) of the SSSC, whereas the foster sample required a three-factor model (combined friend and classmate constructs). The newly defined three-factor model provided significant associations with youth behavioral and emotional outcomes.

CONCLUSIONS

Youth in foster care may perceive social support across sources differently from youth residing in the community.

Discrepancies in youth self-report and case file report of maltreatment and association with internalizing and externalizing symptoms

BACKGROUND

Childhood maltreatment is a potential risk factor for the later development of psychopathology (Jaffee, 2017). However, there is no gold standard for identifying victims of child maltreatment, and when multiple informants - such as case files and youth self-report - are used, these sources often disagree (Cooley & Jackson, 2022).

OBJECTIVE

The current study aimed to explore discrepancies between youth self-report and case file report of maltreatment and examine how these discrepancies related to internalizing and externalizing symptoms.

PARTICIPANTS/SETTING

Participants were 470 youth living in foster care between the ages of 8 and 18 and their caregivers.

METHODS

Latent class analysis (LCA) was used to create novel groups based on informant discrepancies.

RESULTS

Agreement between informants was in the poor-to-fair agreement range for all types of maltreatment. Latent class analysis identified a 3-class solution with significant group differences on both externalizing (Χ² (2, N = 470) = 6.16, p = 0.05) and internalizing symptoms (Χ² (2, N = 470) = 6.10, p = 0.05). Specifically, those in the "self-report only" class had significantly higher symptoms than those in the "neither informant/case file only" class for both internalizing and externalizing behavior.

CONCLUSIONS

Case files and youth self-report of maltreatment are discrepant. Youth self-report of maltreatment history may be more closely linked to psychopathology than case file report of maltreatment. Researchers and practitioners should look to youth self-report rather than relying solely on case files when determining risk for psychopathology.

Altered Spontaneous Brain Activity in Left-Behind Children: A Resting-State Functional MRI Study

Background

Parental migration has been associated with a higher risk of cognitive and behavioral abnormalities in left-behind children (LBC). This study aimed to explore the spontaneous brain activity in LBC and reveal the mechanisms underlying behavioral and cognitive abnormalities.

Methods

Involved LBC (n = 36) and non-LBC (n = 22) underwent resting-state functional MRI (fMRI) examination and cognitive and behavioral assessment. The fMRI-based amplitude of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF) were assessed to analyze the spontaneous brain activity pattern. The relationships among abnormal spontaneous brain activity, behavioral and cognitive deficits and altered family environment were assessed by partial correlation analysis.

Results

Compared with non-LBC, LBC exhibited increased amplitude of low-frequency fluctuations in the right lingual gyrus (LING), while a decreased ALFF was observed in the bilateral insula and right orbital part of the middle frontal gyrus (ORBmid) (two-tailed voxel-level p < 0.01 and cluster-level p <0.05, Gaussian Random Field (GRF) correction). The fALFF in LBC were significantly increased in the left cerebellum 9 (Cbe9) and right cerebellum Crus2 (CbeCru2), while it decreased in the right hippocampus and left superior temporal gyrus (STG) (two-tailed voxel-level p < 0.01 and cluster-level p < 0.05, GRF correction). The ALFF and fALFF values in abnormal brain regions were found to be correlated with the learning ability, except for the right insula, while the fALFF values of the left STG were positively correlated with the full-scale IQ scores (p < 0.05). Moreover, the ALFF and fALFF values in all abnormal brain regions correlated with the education level of caregivers (p < 0.05).

Conclusions

Our study provided empirical evidence that the lack of direct parental care during early childhood could affect brain function development involving cognition, behavior, and emotion. Our findings emphasized that intellectual and emotional cares are essential for LBC.

Academic Functioning of Youth in Foster Care: The Influence of Unique Sources of Social Support

Youth in foster care often experience more difficulty in school compared to their non-foster care peers. Difficulties exist across domains of academic functioning, including both performance (e.g., low grades) and behavioral health (e.g., high externalizing concerns) in school. One factor that has shown to be associated with positive academic functioning in the general population but remains to be comprehensively examined among youth in foster care is social support. This includes examining specific sources of support for youth in foster care and taking into consideration the context of the frequent placement disruptions many children in foster care experience. This study sought to determine which sources of social support are associated with academic functioning for youth in foster care by examining child-report of social support from parents, teachers, friends, and classmates in relation to school grades and teacher-reported behavioral health outcomes. Information on each source of social support was obtained from the self-report of 257 youth in foster care, and information on placement characteristics were obtained from child welfare casefiles. Teachers provided information on youth's behavioral health in school, and academic grades were obtained from school records. Results suggested that youth reported teacher social support, as compared to parent, friend, or classmate social support, was most influential for both performance and behavioral health in school. Findings highlight the need for additional research on the important role of teachers for promoting academic success amongst youth in foster care, as well as the importance of placement changes in relation to academic functioning.

Early Detection of Behavioral and Emotional Problems in School-Aged Children and Adolescents: The Parent Questionnaires

Introduction:

Early detection of behavioral and emotional problems in children and adolescents is relevant. For this purpose, the use of questionnaires completed by parents is applicable. Parent questionnaires are also useful preliminary support to the clinical investigation.

Methods:

Validated tools for the analysis of behavioral and emotional problems suitable for school-age subjects are analyzed in their characteristics and possibilities of use.

Results:

The following are the main characteristics of the instruments examined. The Child and Adolescent Symptom Inventory 4&5, Parent Checklist (CASI-4&5) and Behavior Assessment System For Children - Parent Rating Scales 2&3 (BASC-2&3) include a high number of questions, with exploration extended to almost all possible pathologies.

The Child Behavior Check-List (CBCL) has less items (113), but only 48 refer to DSM pathologies. The use of CASI, BASC and CBCL carries a cost because they are copyrighted.

The Pediatric Symptom Checklist (PSC) has 35 items, but only 17 have a reference to 3 clinical areas. The Strength & Difficulties Questionnaire (SDA) is very short (25 items) and concerns only the main externalizing and internalizing disorders. The Child and Adolescent Behavior Inventory (CABI) has 75 items and explores a wide range of psycho-pathological issues, likewise CASI and BASC. PSC, SDA and CABI can be used free of charge.

Conclusion:

The comparison of the characteristics of the aforementioned questionnaires can guide the psychiatrist and the epidemiologist in choosing the most suitable tool for what is proposed to be assessed, in relation to practicability, extension of the areas explored and costs.

Measurement Based Care in Child Welfare-Involved Children and Youth: Reliability and Validity of the PSC-17

This study evaluates whether the psychometric properties of the Pediatric Symptoms Checklist-17 (PSC-17), a common behavioral health measure typically used as a dichotomous screening tool for mental health needs, support its use as a continuous measure for tracking behavioral health over time. A total of 6492 foster parents of children and youth aged 5.5-17 completed the PSC-17. Convergent and discriminant validity was assessed by comparing raw PSC-17 subscale scores with associated outcomes (e.g. psychiatric diagnoses). Long-term test-retest reliability was assessed over 6 months. Scores on the PSC-17 demonstrated good convergent and divergent validity. PSC-17 subscale scores were most strongly associated with analogous diagnoses. Test-retest reliability was moderate, as expected for a time window of this length. This study provides moderate support for the psychometric qualities of the PSC-17 when used with children and youth in the child welfare system as a continuous measure of psychosocial functioning over time.

Maltreatment, Coping, and Substance Use in Youth in Foster Care: Examination of Moderation Models

Child maltreatment is associated with negative outcomes such as substance use (SU). This study tested relations among maltreatment history, coping behavior, and SU behavior in youth residing in foster care. Participants were 210 youth ( M_age = 12.71 years; SD = 2.95) in foster care who completed self-report measures through an audio computer-assisted self-interview program. Using a structural equation modeling framework and latent measurement constructs, positive associations were identified between maltreatment at baseline and coping behavior outcomes as well as SU behavior outcome approximately 4.5 months later. Specifically, greater severity and chronicity of maltreatment was associated with greater SU behavior as well as indirect action, prosocial, and asocial coping behavior. Maltreatment was not significantly related to direct action coping behavior. In moderation tests, only asocial coping provided a significant interaction effect for SU behavior outcomes; SU behavior did not moderate pathways between maltreatment and coping behavior. For youth in foster care, the coping approach may be varied and relate differentially to SU behavior outcomes, with asocial approaches to coping acting as a buffer for the maltreatment/SU relation. Additionally, SU remains an important target for intervention and prevention in youth residing in foster care.

Child violence experiences in institutionalised/orphanage care

Institutions are not necessarily good environments for children. In the face of challenges such as HIV, Ebola, poverty, conflict and disaster the numbers have grown rather than reduced. Some countries have closed institutions down -driven by findings that cognitive developmental delay is associated with institutional care. Yet insight into abuse and violence within institutionalised settings is neglected. Maltreatment -violence and abuse -may be an issue. This systematic review series addresses violence and abuse experiences in institutionalised care, exploring firstly the frequency of abuse/violence in institutions, secondly any interventions to reduce such violence or abuse and thirdly the perpetrators of such violence or abuse. The final systematic review updates the findings on cognitive delay associated with institutionalised care. With a violence lens, cognitive delay may well be considered under the umbrella of neglect. Maltreatment and abuse may be a driver of cognitive delay. The keyword search covered several electronic databases and studies were included for data abstraction if they met adequacy criteria. Eight studies were identified on the prevalence of abuse in institutions and a further three studies reported on interventions. Only one study was identified documenting peer on peer violence in institutions. Sixty-six studies were identified examining cognitive development for institutionalised children. All but two of these record cognitive deficits associated with institutionalisation. Only two asked about violence or abuse which was found to be higher in institutionalised children. Overall the abuse experiences of children in institutions are poorly recorded, and in one study violence was associated with high suicidal attempts. The major intervention pathway for ameliorating cognitive challenge seems to be placement out of the institutions which shows benefits and redresses some cognitive outcomes - yet not a total panacea. The single study providing training and monitoring of harsh punishment and maltreatment showed immediate and decided reductions. This data suggest, despite the paucity of studies, violence and abuse, by commission or omission is prevalent in institutions, has an effect on child well-being and is amenable to intervention. Simple training or more complex structures to place children within conducive alternative environments (or to avoid institutionalised placements in the first place) seem to be the main pathway of intervention.

Altered brain network topology in left-behind children: A resting-state functional magnetic resonance imaging study

Whether a lack of direct parental care affects brain function in children is an important question, particularly in developing countries where hundreds of millions of children are left behind when their parents migrate for economic or political reasons. In this study, we investigated changes in the topological architectures of brain functional networks in left-behind children (LBC). Resting-state functional magnetic resonance imaging data were obtained from 26 LBC and 21 children living within their nuclear family (non-LBC). LBC showed a significant increase in the normalized characteristic path length (λ), suggesting a decrease in efficiency in information access, and altered nodal centralities in the fronto-limbic regions and motor and sensory systems. Moreover, a decreased nodal degree and the nodal betweenness of the right rectus gyrus were positively correlated with annual family income. The present study provides the first empirical evidence that suggests that a lack of direct parental care could affect brain functional development in children, particularly involving emotional networks.

Psychological Well-Being and Family Environment of Siblings of Children with Life Threatening Illness

BACKGROUND

The psychological well-being of siblings of children with life threatening illness remains largely uncharted. Pediatric cancer research suggests that a supportive family environment may protect the psychological well-being of siblings.

OBJECTIVE

We hypothesized that (1) siblings of pediatric palliative care patients would show clinical/behavioral scores that were elevated but that rates of serious psychopathology would be comparable to the general population of children their age; and (2) higher family functioning scores would be associated with lower clinical scores and higher adaptive scores for these siblings.

METHODS

We conducted an observational study with families in which a patient receiving palliative care had one or more siblings between the ages of 6 and 11. Parents completed the Behavioral Assessment System for Children, Second Edition (BASC-2) to assess the siblings' psychological well-being and the Family Assessment Device (FAD) to assess the family environment.

RESULTS

Twenty-four parents reported data for 30 siblings. Only three siblings scored in the clinical range on a BASC-2 composite clinical scale, and 11 siblings scored in the at-risk range on one or more composite scales. Higher FAD scores predicted significantly higher externalization composite clinical scores (7.54, 95% CI: 1.12, 13.97, p < 0.05) and significantly higher behavioral composite scores (7.88, 95% CI: 1.55, 14.21, p < 0.05).

DISCUSSION

Siblings of pediatric palliative care patients are not experiencing lower psychological well-being than the general population. The prediction that a positive family environment would be associated with higher levels of psychological health was supported.