Early elementary school adjustment of maltreated children in foster care: the roles of inhibitory control and caregiver involvement

Foster children avoidance-related interactive behaviors with caregivers

BACKGROUND

A lot of the research concerning foster children - often children who have suffered maltreatment in the family home - has focused on internalized and externalized symptoms. Few studies, however, have looked at the interactions between such children and caregivers.

PURPOSE

The purpose of this study is to explore the Emotion Regulation Strategies (ERS) of children in foster care and to highlight those most commonly employed in family or placement contexts. The parents' and foster carers' ERS are also analyzed in order to understand the co-regulatory processes at work.

METHOD

An in-depth analysis of observation sequences was performed. Three data collection times, spaced across a period of 6 months (t1, t2 and t3), were included in the observation protocol. Each observation, recorded using a video camera, comprised 45 min of free time and 15 min of structured tasks. Transcription and coding of ERS were performed for each sequence using a microanalytical method. Both children's and adults' ERS were coded.

RESULTS

Children tended to be readily distracted when interacting with adults, and more particularly so with their parents. While they tended to display relatively normative processes with a foster carer, they turned to pathological avoidance mechanisms with their parents such as physical venting or self-stimulation. Interactions during structured tasks showed a significant reduction in distraction processes.

CONCLUSION

This study highlights the prevalence of distraction behavior in foster children during their interactions with caregivers, and offers an insight into how structured interactions provide a framework that mitigates children's avoidance behaviors and so enhances adult-child collaboration.

Exposure to Parental Aggression and the Development of Psychopathology in Young Children: The Mediating Role of Early Dissociative Symptoms

Exposure to child-directed parental aggression in early life has been found to increase the risk of later psychopathological symptoms among children and adolescents. However, little is known about intermediate phenotypes and the developmental progression of symptoms, especially across the transition to grade school. Using prospectively collected longitudinal data from a large sample of children enrolled in the Family Life Project (n = 1,166, 49.7% female), the current study examined the mediating role of early dissociative symptoms in the relations between parental aggression and children's psychopathological symptoms. Children's exposure to parental aggression and their dissociative symptoms before school entry were assessed based on primary caregivers' reports. Teacher ratings of children's internalizing and externalizing symptoms were collected in pre-kindergarten as well as in the 1st, 3rd, and 5th grades. Results showed that dissociative symptoms before school entry partially mediated the association between parental aggression and persistent externalizing symptoms in school years. However, no significant associations were found between parental aggression or dissociative symptoms and internalizing symptoms. Findings suggest that dissociative symptoms manifested early in life serve as a mediating mechanism and indicator of risk for persistent impulsivity and behavioral problems. Thus, these symptoms could be an important target of preventive services provided to children with adverse experiences in their families.

Perspective Taking Ability in Psychologically Maltreated Children: A Protective Factor in Peer Social Adjustment

Perspective taking is conceptualized as a multidimensional construct characterized by three components: cognitive, affective, and visual. The experience of psychological maltreatment impairs the child's emotional competence; in particular, maltreated children present difficulty in understanding and regulating emotions and in social understanding ability. In addition, the literature contains several contributions that highlight maladaptive behaviors of children with a history of maltreatment in peer interactions in the school context. Perspective taking ability has rarely been studied in maltreated children and the existing studies have produced different and often conflicting results that require further insights. On the grounds of these premises, the main objective of the present research is to investigate perspective taking ability in preschool children from maltreating and non-maltreating family contexts and its role in social adjustment, in terms of prosocial and aggressive behavior toward peers inside the kindergarten. A second objective is to verify the effectiveness of a training aimed to promote perspective taking ability in victims of psychological maltreatment. This research, organized into two separate studies, involved 249 preschool children: 206 children from non-maltreating family contexts and 43 brought up in psychologically maltreating families. Perspective taking was measured via the administration of several tests, and prosocial behavior and aggressiveness were observed via non-participant observations in the school context. The training involved maltreated children in small-group meetings based on familiar and appealing activities within the mother-child community. The overall results show that children's perspective taking ability, in particular the affective perspective taking, contributed to social adjustment. In fact, greater affective perspective taking ability was correlated to a higher frequency of prosocial behaviors toward peers and minor frequency of aggressiveness. Finally, the results of the training (pre/post-test comparison) showed an increase in perspective taking, especially in the affective dimension, and a consequent increase in prosocial behaviors and a decrease in aggressive ones. Therefore, the affective perspective taking ability seems to represent a very significant protective factor, which should be focused and strengthened in order to improve the social adaptation of preschool children who are victims of psychological abuse.

Effects of a school readiness intervention on electrophysiological indices of external response monitoring in children in foster care

This study examined the impact of a school readiness intervention on external response monitoring in children in foster care. Behavioral and event-related potential (ERP) data were collected during a flanker task from children who received the Kids In Transition to School (KITS) Program (n = 26) and children who received services as usual (n = 19) before and after the intervention. While there were no significant group differences on the behavioral data, the ERP data for the two groups of children significantly differed. Specifically, in contrast to the children who received services as usual, the children who received the KITS Program displayed greater amplitude differences between positive and negative performance feedback over time for the N1, which reflects early attention processes, and feedback-related negativity, which reflects evaluation processes. In addition, although the two groups did not differ on amplitude differences between positive and negative performance feedback for these ERP components before the intervention, the children who received the KITS Program displayed greater amplitude differences than the children who received services as usual after the intervention. These results suggest that the KITS Program had an effect on responsivity to external performance feedback, which may be beneficial during the transition into kindergarten.

Early parenting intervention accelerates inhibitory control development among CPS-involved children in middle childhood: A randomized clinical trial

Children at risk for neglect or abuse are vulnerable to delays in inhibitory control development. Prior findings suggest that early parenting interventions that target parental sensitivity and responsiveness during infancy can improve executive function outcomes of high-risk children during preschool years; however, little is known about how persistent these gains are through middle childhood. Participants included 76 CPS-involved children who were randomly assigned to either the ABC intervention (N = 32) or the Developmental Education for Families (DEF) control intervention (N = 44), and 53 low-risk children. Children completed the Stop Signal Reaction Time (SSRT) paradigm at ages 8 and 10. Intervention group predicted performance on the SSRT at age 8 such that children who received the ABC intervention and children in the low-risk group performed significantly better than children who received the DEF intervention (ABC vs. DEF: Cohen's d = 0.92; low-risk group vs. DEF: d = 0.56). The performances of the ABC and the low-risk groups were not statistically different. There were no significant group differences in SSRT performance at age 10. These findings demonstrate that the ABC intervention has long-term beneficial effects on inhibitory control development in children with a history of early caregiving adversity. A video abstract of this article can be viewed at https://youtu.be/P9oLyfo7pYA.

Social Support Is Related to the Use of Adaptive Emotional Regulation Strategies in Ecuadorian Adolescents in Foster Care

Adolescents in foster care are exposed to maltreatment and inadequate social support which can have lasting repercussions on their emotional development. The aim of this study was to examine the effect of social support on the use of emotional regulation strategies in Ecuadorian adolescents in foster care and non-foster peers. This study recruited 181 adolescents, 56 in foster care and 123 non-foster peers, from various locations in Quito, Ecuador. Participants completed the Cognitive Emotion Regulation Questionnaire (CERQ) and the Multidimensional Scale of Perceived Social Support (MSPSS). Using linear regression, we found that being in foster care was related to lower perceived social support. The non-foster care control group reported using more emotion regulation strategies, both adaptive and maladaptive (acceptance, rumination, refocusing to planning, and self-blaming), than the foster care group. Greater social support was associated with the use of more positive strategies (reappraisal, positive refocusing, and refocusing to planning) and less maladaptive strategies (catastrophizing). Youth in foster care have less social support than their non-foster peers. This puts them at risk, as social support has an important role in the use of healthy emotion regulation skills in adolescents.

Developing a model of care for substance use in pregnancy and parenting services, Sydney, Australia: Service provider perspectives

INTRODUCTION

The absence of a clear model of care for services supporting pregnant women and mothers with substance use disorders has impeded opportunities to build an evidence base for the effectiveness of these services. Previous research has typically focused on the needs of pregnant women or mothers, as two distinct groups. This paper explores service providers' perceptions of key components of a model of care, extending from perinatal care to community-based support for up to 17 years post-delivery. A model of care is outlined and feasibility factors affecting implementation are highlighted.

METHODS

Qualitative methods were adopted as a first step to informing development of the model of care. Semi-structured in-depth interviews were conducted with thirty-eight staff providing a range of substance use in pregnancy and parenting services (SUPPS) in hospital and community-based agencies, in a metropolitan health district in Sydney, Australia. Interview data was entered into NVivo and analysed using constant comparative methods.

RESULTS

Guiding principles for the model of care included integrated care, harm reduction and person-centredness. Practice approaches integral to the model of care were promoting engagement with women, flexible service provision, trauma-informed care, and continuity of care. Feasibility factors influencing implementation of the model of care included fragmentation or siloing of the service network and workforce sustainability.

CONCLUSIONS

A harm reduction approach was crucial for promoting engagement of women with SUPPS, particularly child protection services. A greater focus on providing ongoing community-based support for mothers also has the potential to achieve sustainable positive outcomes for women and children. Implementation of the SUPPS model of care could be undermined by threats to integration of service delivery and continuity of care. Further research is needed to explore consumer perspectives and inform the model of care as a framework for evaluation.

Childhood Maltreatment Is Associated With Aggression Among Male Juvenile Delinquents in China: The Mediating Effects of Callous-Unemotional Traits and Self-Control

Background: Aggression is an important risk factor for delinquency and crime in adolescents. Previous studies have indicated that childhood maltreatment plays an important role in the development of aggression. However, whether the effect could be mediated by other factors is still unknown. Evidence suggests that callous-unemotional (CU) traits and self-control may be candidate mediators in the relationship between childhood maltreatment and aggression.

Methods: A total of 585 male juvenile delinquents from China were recruited for the present study. We measured self-reported childhood maltreatment, CU traits, self-control, and aggression with the short form of the Childhood Trauma Questionnaire (CTQ-SF), the Inventory of Callous-Unemotional Traits (ICU), the Self-Control Scale (SCS), and the Aggression Questionnaire (AQ), respectively. Furthermore, we constructed multiple mediation models to investigate the mediating effects of CU traits and self-control on the relationship between childhood maltreatment and aggression. Childhood maltreatment and aggression were entered into the model as the independent and dependent variables, respectively, and CU traits and self-control were treated as the mediating variables. In addition, the moderating role of self-control in the relationship between childhood maltreatment and aggression was tested by constructing a moderation model.

Results: Correlation analysis showed significant positive correlations among childhood maltreatment, CU traits, and aggression (all r values > 0.31, P values < 0.01), and self-control was negatively correlated with these three factors (all r values < −0.32, P values < 0.01). Mediation analyses showed that the relationship between childhood maltreatment and aggression was completely and sequentially mediated by the factors of CU traits and self-control (indirect effect = 0.31, P < 0.001). In addition, the relationship between childhood maltreatment and aggression could also be completely mediated by CU traits (indirect effect = 0.24, P < 0.001) and self-control (indirect effect = 0.26, P < 0.001) separately.

Conclusion: Our results indicate that, in a sample of male juvenile delinquents in China, the relationship between childhood maltreatment and adolescent aggression was found to be mediated by CU traits and self-control, which may shed light on the development of aggression among male juvenile delinquents.

Dyadic synchrony and repair processes are related to preschool children's risk exposure and self-control

We examined associations between preschool children's cumulative risk exposure, dyadic interaction patterns, and self-control abilities in 238 mother-child dyads. Positive interactive synchrony, relationship ruptures, and latency to repair were micro-coded during a 3-5 minute joint challenge task. Children's self-control was assessed via two laboratory tasks and by parent report. Structural equation modeling and mediation analyses were utilized to examine the direct and indirect effects of cumulative risk on children's observed and parent-reported self-control abilities. Parent-child interactive processes of dyadic synchrony and latency to repair ruptures in synchrony were examined as mediators. Dyadic synchrony and latency to repair ruptures were found to mediate associations between cumulative risk exposure and children's behavioral and parent-reported self-control. Children exposed to more cumulative risk engaged in less dyadic synchrony and experienced longer latencies to repair ruptures with their caregiver, which in turn was associated with lower child self-control. Though cross-sectional, findings suggest dyadic synchrony and repair processes may represent viable mechanistic pathways linking cumulative risk exposure and deficits in child self-control. However, independent replications using longitudinal and experimental intervention designs are needed to determine causal pathways and inform new approaches for targeting the effects of early risk exposure through a focus on two-generational interventions.

Emotion Regulation among Children in Foster Care Versus Birth Parent Care: Differential Effects of an Early Home-Visiting Intervention

Children involved with Child Protective Services (CPS) often show worse emotion regulation than non-involved children, with downstream effects on adaptive functioning. The current study uses two randomized control trials, one conducted with foster caregivers and one conducted with birth parents, to investigate the longitudinal effects of caregiver type (foster versus birth parent) and a home-visiting parenting intervention on emotion regulation among young children referred to CPS. Participants were 211 children referred to CPS during infancy or toddlerhood, of whom 120 remained with their birth parents and 91 were placed in foster care. Caregivers were randomly assigned to receive Attachment and Biobehavioral Catch-Up (ABC), a 10-session intervention designed to promote nurturing, sensitive, and non-intrusive caregiving, or a control intervention. Caregiver type moderated the effects of ABC on young children's observed anger dysregulation during a frustrating task at age 2 to 3 years. Among children remaining with their birth parents, children whose caregivers received ABC showed lower anger dysregulation than children whose caregivers received the control intervention. Children placed in foster care showed lower anger dysregulation than children with birth parents regardless of parenting intervention, and additionally showed higher adaptive regulation than children remaining with their birth parents. Adaptive regulation was not significantly associated with parenting intervention or the caregiver by intervention interaction. Results suggest that foster care placement may be protective for emerging emotion regulation skills among young children referred to CPS, and an attachment-based parenting intervention buffers risks of remaining in the home for young children's emotion dysregulation.

Indirect effects of the early childhood Family Check-Up on adolescent suicide risk: The mediating role of inhibitory control

This study investigates suicide risk in late childhood and early adolescence in relation to a family-centered intervention, the Family Check-Up, for problem behavior delivered in early childhood. At age 2, 731 low-income families receiving nutritional services from Women, Infants, and Children programs were randomized to the Family Check-Up intervention or to a control group. Trend-level main effects were observed on endorsement of suicide risk by parents or teachers from ages 7.5 to 14, with higher rates of suicide risk endorsement in youth in the control versus intervention condition. A significant indirect effect of intervention was also observed, with treatment-related improvements in inhibitory control across childhood predicting reductions in suicide-related risk both at age 10.5, assessed via diagnostic interviews with parents and youth, and at age 14, assessed via parent and teacher reports. Results add to the emerging body of work demonstrating long-term reductions in suicide risk related to family-focused preventive interventions, and highlight improvements in youth self-regulatory skills as an important mechanism of such reductions in risk.

Exploring the Psychometric Properties of the Parent Daily Report - Toddler Version (PDR-T)

The present study examined the psychometric properties of a brief parent-report daily checklist of toddler behavior (Parent Daily Report - Toddler Version; PDR-T). Data were collected from three groups of 18-36 month-olds who were followed longitudinally for approximately 1 year: 1) internationally adopted children (n = 156), 2) children placed in foster care due to child maltreatment (n = 79), and 3) community comparison children raised by their biological families (n = 80). An exploratory factor analysis of this measure resulted in three factors, measuring aggressive/noncompliant, positive, and distress behaviors. While there were estimation issues with the positive and distress factors, the aggressive/noncompliant factor exhibited invariance across time and groups, and partial invariance between genders. Significant correlations were observed between this factor and measures of externalizing behavior and inhibitory control (r = .26-.56), but not shyness, fearfulness, or negative affect. This provides support for both convergent and discriminant validity. Reliability of this factor was adequate to good across time and group. Results provide preliminary support for the utility, reliability, and consistency of one factor of the PDR-T as an easy parent-report tool to assess daily patterns and changes in child aggressive/noncompliant behavior over time.

Does dose of early intervention matter for preschoolers with externalizing behavior problems? A pilot randomized trial comparing intensive summer programming to school consultation

The goals of this study were to (a) isolate the ideal length (i.e., 4 or 8 weeks) of the Summer Treatment Program for Kindergarteners (STP-PreK) for improving school readiness and kindergarten success outcomes of preschool children with externalizing behavior problems (EBPs) during the transition to kindergarten; and (b) compare the STP-PreK model to a more standard approach in school settings (i.e., behavioral school consultation). Forty-five preschool children (82% boys; Mage = 5.16 years; 93% Hispanic/Latino background) were randomized to one of three intervention conditions: 1) 8-week STP-PreK (8W); 2) 4-week STP-PreK (4W); or 3) school year behavioral consultation (SC). Both STP-PreK groups included an 8-week parent training component. Baseline, post-intervention, and 6-month follow-up data were collected on children's school readiness and kindergarten success outcomes including parent, teacher, and objective assessment measures. Analyses using linear mixed models indicated that children's behavioral, academic, social-emotional, and self-regulation functioning significantly improved across groups. Few significant differences were found between children receiving the 4W and 8W programs, suggesting that both programs have the potential to prepare preschool children with EBP for the transition to school. Both 4W and 8W groups experienced greater initial growth across time in most domains compared to children in the SC group. However, by the end of the kindergarten year, children in the SC group caught up to children in both 4W and 8W groups on most domains. Overall, these findings suggest that all three intervention doses are effective in improving kindergarten year functioning, with some important considerations for intervention timing in preparation for the transition to elementary school. Clinical implications for school personnel are discussed.

Early psychosocial deprivation and adolescent risk-taking: The role of motivation and executive control

Risk-taking in adolescence has been often associated with early life adversities. However, the impact of such macrolevel factors on risk behavior has been rarely studied in humans. To address these gaps we recruited a sample of young adolescents who were part of a randomized control trial of foster care. Children institutionalized at or soon after birth were randomly assigned either to be removed from institutions and placed into a family or foster care intervention or to remain in institutions receiving care as usual. These children were subsequently followed up through 12 years of age and compared with a sample of children who had never been institutionalized. Using this sample, we examined the impact of early childhood deprivation on risk-taking behavior and explored the role of motivation (i.e., sensation seeking) and executive control (i.e., planning). Early psychosocial deprivation decreased engagement in risk-taking among young adolescents by reducing sensation seeking, a motivation often associated with risk-taking in adolescence. The impact of early psychosocial deprivation on sensation seeking and consequently on engagement in risk-taking was further reduced by its deleterious effects on executive control. These findings challenge the traditional view according to which risk behavior is a maladaptive response to adversities and suggest that it may represent adolescents' attempts to fulfill important motivations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Placement in Care in Early Childhood and School Readiness: A Retrospective Cohort Study

The current study examined school readiness for children placed in care of child protection services before age 5. This association was assessed using a population-based cohort of children born in Manitoba, Canada, between 2000 and 2009 ( n = 53,477) and subcohorts of discordant siblings (one sibling taken into care, one sibling not taken into care; n = 809) and discordant cousins ( n = 517). In the population analysis, children placed in care were significantly less likely to be ready for school; this difference was not seen in the discordant sibling or cousin analysis. The findings suggested that differences in school readiness for children placed in care are a result of broader social factors affecting families, not placement into care.

Investigating multilevel pathways of developmental consequences of maltreatment

The impact of maltreatment spreads across many developmental domains and extends across the entire life span. Identifying unidirectional or bidirectional drivers of developmental cascades of the effects of maltreatment experiences is critical to efficiently employing interventions to promote resilient development in maltreated children. This 1-year longitudinal study utilized a multiple-levels approach, investigating "bottom-up" and "top-down" cascades using structural equation modeling between cortisol regulation, externalizing behavior, and peer aggression. Neither a bottom-up model driven by cortisol regulation nor a top-down model driven by peer aggression fit the data well. Instead, lower rates of externalizing behavior at Year 1 most strongly predicted improvements at all levels of analysis (reduced cortisol, externalizing behavior, and peer aggression) at Year 2. These results provide initial indication of a mechanism through which interventions for maltreated children may be most effective and result in the most substantial positive changes across developmental domains.

Leveraging translational neuroscience to inform early intervention and addiction prevention for children exposed to early life stress

Substance use and addiction are disproportionately experienced by individuals with a history of exposure to early life stress (ELS), such as maltreatment, domestic violence and parent psychopathology. Unfortunately, extant interventions have mixed effectiveness at improving outcome trajectories for ELS-exposed children, who are often underserved by evidenced-based programs. Here, we employ a translational neuroscience framework to delineate how neuroscience can deepen our understanding of ELS-linked alterations in children's function to inform the development of more targeted, effective early intervention and addiction prevention programs. Candidate neural pathways altered by ELS and linked to addiction are described across sensory, affective, motivational, and executive function domains. Next, we provide an example of the application of translational neuroscience principles in a family of early interventions (i.e. Multidimensional Treatment Foster Care – Preschool, Kids in Transition to School) focused on improving self-regulation in ELS-exposed children. Future directions and areas of unmet need in intervention research detail the significant potential of translational neuroscience to advance interventionists' ability to support positive adjustment in ELS-exposed children and prevent harmful addiction outcomes.

Maternal sensitive guidance during reminiscing in the context of child maltreatment: Implications for child self-regulatory processes

The manner in which mothers engage in emotional discussion, or reminisce, with their young children about past emotional experiences poses important ramifications for child socioemotional and cognitive development. Maltreating mothers may have difficulty engaging in emotionally supportive reminiscing. The current study examined the role of maternal sensitive guidance during reminiscing as a process variable that may explain associations between child maltreatment and 3 child self-regulatory dimensions: lability/negativity, emotion regulation, and inhibitory control. Participants included 111 maltreating and 65 demographically matched, nonmaltreating mothers and their 3- to 6-year-old children (N = 176). The dyads participated in a joint reminiscing task about 4 past emotional shared experiences. Mothers reported on their children's emotion regulation and lability/negativity while children participated in a behavioral assessment of inhibitory control. Results indicated that maltreating mothers engaged in less sensitive guidance when reminiscing compared with nonmaltreating mothers. In the main analysis, maternal sensitive guidance mediated relations between maltreatment and child emotion regulation and inhibitory control, respectively, but not lability/negativity. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Cumulative risk exposure moderates the association between parasympathetic reactivity and inhibitory control in preschool-age children

A child's cumulative risk for early exposure to stress has been linked to alterations of self-regulation outcomes, including neurobiological correlates of inhibitory control (IC). We examined whether children's ability to engage the parasympathetic nervous system impacts how risk affects IC. Children ages 3-5 years completed two laboratory measures of IC while respiratory sinus arrhythmia (RSA) was measured, indexing parasympathetic activity. Children with greater risk demonstrated lower IC; risk also moderated associations between RSA reactivity and IC. For children with less risk, greater RSA withdrawal during IC tasks was associated with better IC. In contrast, greater risk was associated with poor IC, regardless of RSA withdrawal. Effects of risk were more pronounced for cumulative than individual measures. Results suggest that cumulative risk exposure disrupts connectivity between physiological and behavioral components of self-regulation in early childhood. Parasympathetic withdrawal to cognitive tasks may be less relevant for performance in developmental samples experiencing greater life stress.

Examining Morning HPA Axis Activity as a Moderator of Hostile, Over-reactive Parenting on Children's Skills for Success in School

This study examined children's morning HPA axis activation as a moderator of links between hostile, over-reactive parenting at age 4.5 years and children's skills for success in school (higher executive function and literacy, and less externalizing behavior) at age 6. Participants included 361 adoptive families. Parenting was self-reported. HPA axis activation was measured by basal levels in morning cortisol. Executive function and literacy were assessed via standardized tasks. Externalizing behavior was reported by teachers. Results indicated that hostile, over-reactive parenting predicted more externalizing behavior and lower executive functioning regardless of children's morning HPA axis activation. HPA axis activation moderated the effects of hostile, over-reactive parenting on literacy. Among children with moderate to high morning HPA axis activation (approximately 60% of the sample), harsh parenting was linked with lower literacy; children with low morning HPA axis activation exhibited better literacy in the context of more hostile, over-reactive parenting. Yet, across the sample, hostile, over-reactive parenting remained in the low to moderate range, not in the high range. Findings are discussed in the context of considering not only whether children's stress system activation moderates responses to their environments, but also how these processes operate for different developmental outcomes.

School readiness of maltreated preschoolers and later school achievement: The role of emotion regulation, language, and context

Guided by bio-ecological theory, this study aimed to: (1) identify heterogeneity in the developmental patterns of emotion regulation for maltreated preschool-aged children; (2) examine the role of gender, language, placement instability, cognitive stimulation, and emotional support on patterns of stability and change of emotion regulation over time; and (3) elucidate the role of emotion regulation/dysregulation patterns on later academic achievement. This study utilized data from the first cohort of the National Survey of Child and Adolescent Well-Being. Results using LCA and LTA models indicated stability and change in emotionally regulated vs. emotionally dysregulated latent classes across 4, 5, and 6 ½ years of age. Placement instability significantly increased the likelihood of being classified as emotionally dysregulated at wave 1. Moreover, children classified as emotionally dysregulated by age 6 ½ scored significantly lower than children who were classified as emotionally regulated on measures of reading and math achievement by age 10. Based on these findings, placement stability at first contact with CPS should be promoted in order to prevent cascading negative effects on emotion regulation. Additionally, children who are more emotionally dysregulated by the time they transition to formal schooling should receive increased socioemotional and socioemotional learning supports.

Cost Effectiveness of a School Readiness Intervention for Foster Children

OBJECTIVE

Many young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).

METHOD

Randomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.

RESULTS

KITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.

CONCLUSIONS

The cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefits and improvements in school readiness for young children in foster care.

Effects of the ABC Intervention on Foster Children's Receptive Vocabulary: Follow-Up Results From a Randomized Clinical Trial

Children with histories of maltreatment and disruptions in care are at elevated risk for impairments in early language development, which contribute to difficulties in other developmental domains across childhood. Given research demonstrating associations between parent responsiveness and children's early language development, we examined whether a parenting intervention administered in infancy improved preschool receptive language skills in children involved with the child welfare system. Attachment and Biobehavioral Catch-up (ABC) is a 10-session intervention that aims to enhance parent-child interactions. The follow-up results of this randomized clinical trial demonstrated that infants who received the ABC intervention ( n = 24) scored significantly higher on a test of receptive vocabulary at age 36 months than infants who received a control intervention ( n = 28). These results provide evidence of the critical role of parental responsiveness in supporting optimal language development among young children with histories of child welfare involvement.

Enhancing executive functioning among toddlers in foster care with an attachment-based intervention

Young children in foster care often experience adversity, such as maltreatment and lack of stability in early caregiving relationships. As a result, these children are at risk for a range of problems, including deficits in executive functioning. The Attachment and Biobehavioral Catch-up for Toddlers (ABC-T) intervention was designed to help foster parents behave in ways that promote the development of young children's emerging self-regulatory capabilities. Participants included 173 parent-toddler dyads in three groups: foster families that were randomly assigned to receive either the ABC-T intervention (n = 63) or a control intervention (n = 58), as well as low-risk parent-toddler dyads from intact families (n = 52). At a follow-up conducted when children were approximately 48 months old, children's executive functioning abilities were assessed with the attention problems scale of the Child Behavior Checklist (Achenbach & Rescorla, 2000) and a graded version of the Dimensional Change Card Sort developed for preschoolers (Beck, Schaefer, Pang, & Carlson, 2011). Results showed that foster children whose parents received the ABC-T intervention and low-risk children never placed in foster care had fewer parent-reported attention problems and demonstrated greater cognitive flexibility during the Dimensional Change Card Sort than foster children whose parents received the control intervention. These results indicate that an attachment-based intervention implemented among toddlers in foster care is effective in enhancing children's executive functioning capabilities.

Child maltreatment and emotion socialization: Associations with executive function in the preschool years

This study examined executive function (EF) among preschoolers exposed to maltreatment, and tested whether caregiver practices related to emotion socialization (e.g., reactions to children's emotions; discussion of emotion) moderate the relationship between maltreatment and EF in this period. Participants were (n=107) children aged 4-5 years (M=4.75; SD=0.57; 39% female), with various levels of exposure to maltreatment. Using the Maltreatment Classification System, substantiated reports of maltreatment were coded to produce an index of the multiplicity of abuse subtypes to which children had been exposed. EF was indexed using a composite of scores on three performance-based tests (Happy-Sad Stroop Task; Tapping Test; Dimensional Change Card Sort). Caregivers reported on their use of emotion related socialization behaviors (ERSBs) with the Coping with Children's Negative Emotions Scale. Exposure to maltreatment and ERSBs were both found to account for unique variance in EF, independent of developmental-ecological factors including children's receptive language and maternal depression. Significant interactions between maltreatment and ERSBs were also found to suggest that nonsupportive ERSBs (e.g., punitive reactions to negative child emotion) may amplify the risk for poor EF associated with maltreatment, whereas supportive ERPBs (e.g., expressive encouragement) protect against it.

The Role of Participant Responsiveness on a Socio-Emotional Learning Program

The present study set out to evaluate participant responsiveness, one of the main dimensions of implementation quality, in a Socio-Emotional Learning after-school program using Educational Dance activities, Experiencing Emotions, and also to understand its influence on program outcomes. The sample involved 98 middle-school Portuguese pupils, 53 of whom participated in the program and 45 in after-school control sessions. Outcome measures included pre-test and post-test questionnaires of pupils' socio-emotional skills, well-being and school engagement. A self-report item measured pupils' satisfaction at the end of the program, and a checklist measuring attendance and homework completion was filled in by the facilitator at each session of the program and control condition. Results revealed (1) high levels of pupils' satisfaction and attendance, and a medium-high level of homework completion towards the program; (2) that pupils' higher attendance rate in the program predicted higher results in the self-management (p = .04, d = .57; p = .003, d = .87) and social awareness (p = .04, d = .59) SEL domains, emotional (p = .02, d = .67) and psychological (p = .009, d = .76) well-being and school engagement (p = .04, d = .56); (3) that pupils' higher rate of homework completion in the program predicted higher results in the relationship skills SEL area (p = .04, d = .59) and in school engagement (p = .005, d = 1.50); (4) that pupils' from the control condition higher rates of homework completion also predicted better school engagement (p = .006, d = .88). Implications for research and practice are discussed.

Children's Executive Function in a CPS-Involved Sample: Effects of Cumulative Adversity and Specific Types of Adversity

Prior research has identified the presence of executive function (EF) deficits in child protective service (CPS) involved (versus non-involved) children but minimal work has examined predictors that might explain individual differences within these CPS-involved children. Here, we sought to characterize EF in a large sample (N=694) of CPS-involved children and examine how specific adversities (physical abuse, neglect, caregiver domestic violence, and caregiver substance dependence) and cumulative adversity (at ages 0-3 and 3-6 years) predict EF (at approximately 5-6 years). It was expected that the sample would exhibit low EF overall based on previous research in maltreated children. Specific adversity and cumulative adversity analyses were largely exploratory given the limited previous work in this area. Results indicated poor EF overall, with 43.5% of children performing worse than chance. Amongst children who performed greater than chance, higher cumulative adversity, physical abuse, and caregiver substance use (at ages 3-6 years) predicted better EF. These findings join literature documenting that, within CPS-involved children, the presence of certain adversities predicts variable cognitive function. Findings highlight the potential relevance of evolutionary psychology to understanding how alterations in behavior linked to harsh and unpredictable early environments may cue accelerated brain development underlying relative cognitive advantages, within at-risk, low performing samples. Longitudinal studies are critical to determine if the relative EF advantages linked to higher adversity persist over time or result in lower EF later on, reflecting a more rapid, but overall limited, trajectory of cognitive development.

Nutritional status of foster children in the U.S.: Implications for cognitive and behavioral development

OBJECTIVE

Children in foster care are at greater risk for poor health, physical, cognitive, behavioral, and developmental outcomes than are children in the general population. Considerable research links early nutrition to later cognitive and behavioral outcomes. The aim of this narrative review is to examine the prevalence of poor nutrition and its relation to subsequent health and development in foster children.

METHOD

Relevant studies for inclusion were identified from numerous sources (e.g., PubMed, Google Scholar, and reference sections). Inclusion criteria were studies published between 1990 and 2016 of (i) the nutritional status of children in foster care or (ii) the nutritional status of children exposed to early adversity (e.g., low-income and internationally adopted children) or (iii) the developmental effects of poor nutrition and micronutrient deficiencies.

RESULTS

Two key findings that have adverse implications for cognitive development emerged: (i) the prevalence of anemia and iron-deficiency anemia is higher among foster children than among the general population of children in the U.S., and (ii) the developmental demands of catch-up growth post-placement may lead to micronutrient deficiencies even after children have begun sufficient dietary intake of these nutrients. Moreover, there is a paucity of recent studies on the nutritional status of children in foster care, despite the multiple factors that may place them at risk for malnutrition.

CONCLUSION

Attention to nutritional status among care providers and medical professionals may remove one of the possible negative influences on foster children's development and in turn significantly alter their trajectories and place them on a more positive path early in life. Recommendations for further research, policy, and practice are discussed.

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.

Can Parenting Intervention Prevent Cascading Effects From Placement Instability to Insecure Attachment to Externalizing Problems in Maltreated Toddlers?

Multiple placement changes disrupt continuity in caregiving and undermine well-being in children in child welfare. This study conducted secondary data analysis of a randomized controlled trial to examine whether a relationship-based intervention, Promoting First Relationships(©) (PFR), reduced risk for a maladaptive cascade from placement instability to less secure attachment to elevated externalizing problems. Participants included caregivers (birth or foster/kin) of toddlers (10-24 months) recently transitioned to their care because of child welfare placement decisions. Although main effects of PFR on security and externalizing problems were not previously observed, this study's results revealed that PFR attenuated the association between multiple placement changes (baseline) and less security (postintervention) and that the indirect effect of placement instability on greater externalizing problems (6-month follow-up) via less security was evident only in toddlers in the comparison condition. These findings shed light on how a history of multiple caregiver changes may influence toddlers' risk for poor adjustment in subsequent placements, and the promise of supporting caregivers through a parenting intervention to prevent such risk.

Emotion Regulation in Sexually Abused Preschoolers

Emotion regulation is closely related to mental health in children and adults. Low emotion regulation competencies have been found in school-aged sexually abused girls. The aim of the present study was to investigate emotion regulation competencies in sexually abused preschool girls and boys using a multi-informant approach. Emotion regulation was assessed in 62 sexually abused and 65 non-abused preschoolers using the Emotion Regulation Checklist and the MacArthur Story Stem Battery. Both parents and educators reported lower emotion regulation competencies in sexually abused preschoolers, especially boys, than in non-abused children. The narrative task completed by the children also revealed lower emotion regulation competencies in sexually abused boys. These findings could have an important impact on intervention programs offered to these at-risk children.

Disruptions of working memory and inhibition mediate the association between exposure to institutionalization and symptoms of attention deficit hyperactivity disorder

BACKGROUND

Young children raised in institutions are exposed to extreme psychosocial deprivation that is associated with elevated risk for psychopathology and other adverse developmental outcomes. The prevalence of attention deficit hyperactivity disorder (ADHD) is particularly high in previously institutionalized children, yet the mechanisms underlying this association are poorly understood. We investigated whether deficits in executive functioning (EF) explain the link between institutionalization and ADHD.

METHOD

A sample of 136 children (aged 6-30 months) was recruited from institutions in Bucharest, Romania, and 72 never institutionalized community children matched for age and gender were recruited through general practitioners' offices. At 8 years of age, children's performance on a number of EF components (working memory, response inhibition and planning) was evaluated. Teachers completed the Health and Behavior Questionnaire, which assesses two core features of ADHD, inattention and impulsivity.

RESULTS

Children with history of institutionalization had higher inattention and impulsivity than community controls, and exhibited worse performance on working memory, response inhibition and planning tasks. Lower performances on working memory and response inhibition, but not planning, partially mediated the association between early institutionalization and inattention and impulsivity symptom scales at age 8 years.

CONCLUSIONS

Institutionalization was associated with decreased EF performance and increased ADHD symptoms. Deficits in working memory and response inhibition were specific mechanisms leading to ADHD in previously institutionalized children. These findings suggest that interventions that foster the development of EF might reduce risk for psychiatric problems in children exposed to early deprivation.

Multigenerational links between mothers' experiences of autonomy in childhood and preschoolers' respiratory sinus arrhythmia: Variations by maltreatment status

Despite burgeoning evidence linking early exposure to child maltreatment (CM) to deficits in self-regulation, the pathways to strong regulatory development in these children are not well understood, and significant heterogeneity is observed in their outcomes. Experiences of autonomy may play a key role in transmitting self-regulatory capacity across generations and help explain individual differences in maltreatment outcomes. In this study, we investigated multigenerational associations between Generation 1 (G1)-Generation 2 (G2) mothers' early experience of warmth and autonomy in relation to their own mothers and their Generation 3 (G3) children's autonomic physiological regulation in CM (n = 85) and non-CM (n = 128) families. We found that G2 mothers who recalled greater autonomy in their childhood relationship with their G1 mothers had preschool-age G3 children with higher respiratory sinus arrhythmia at baseline when alone while engaged in individual challenge tasks, during social exchanges with their mother in joint challenge tasks, and during the portions of the strange situation procedure when the mother was present. Although no clear mediators of this association emerged, multigenerational links among G1-G2 relations, maternal representations of her child, child behavior, and child respiratory sinus arrhythmia differed by maltreatment status, thus possibly representing important targets for future research and intervention.

Out of Control

Family violence is common and brings tremendous costs to individuals, relationships, and society. Victims are vulnerable to negative outcomes across a host of dimensions, including cognitive performance, impulse control, emotion regulation, and physical health. Links between family violence and various problems have been established, yet the specific processes underlying these associations are poorly understood, resulting in the stunted development of effective interventions. This article addresses two key questions: How and why does family violence cause these myriad problems? The self-control strength model of family violence provides novel answers. The model integrates components of existing theories, extending them by pinpointing self-control strength as an explanatory and predictive factor, and can serve as a framework for interventions.

Foster Caregivers' Perspectives on the Medical Challenges of Children Placed in Their Care: Implications for Pediatricians Caring for Children in Foster Care

OBJECTIVE

To investigate, using qualitative methodology, foster caregivers' perspectives related to the medical needs of children placed in their care.

STUDY DESIGN

Fifteen foster caregivers were individually interviewed using a semistructured open-ended question guide. Data were coded, and the analysis was conducted in an inductive manner, allowing themes to emerge from the interviews.

RESULTS

The following 4 themes were identified: (1) the fragmented histories provided to foster caregivers and difficulty in obtaining information; (2) the unique medical complications that children in foster care experience; (3) the difference between "doing what is expected" and becoming a proactive foster caregiver; and (4) the support needs of foster caregivers.

CONCLUSIONS

Foster caregivers receive insufficient information despite the evidence that these children are likely to have complex needs. It is, therefore, necessary for the pediatrician to recognize existing medical problems, identify new medical problems, educate foster caregivers, and communicate with the multidisciplinary team.

Adverse Consequences of School Mobility for Children in Foster Care: A Prospective Longitudinal Study

Few prospective studies have examined school mobility in children in foster care. This study described the school moves of 86 such children and 55 community comparison children (primarily Caucasian), living in a medium-sized metropolitan area in the Pacific Northwest who were approximately 3 to 6 years old at the study start. Additionally, the effects of moves from kindergarten through Grade 2 on academic and socioemotional competence in Grades 3 through 5 were examined. A greater number of early school moves was associated with poorer later socoemotional competence and partially mediated the effects of maltreatment and out-of-home placement on socioemotional competence. This was the case only for children with poorer early learning skills in kindergarten. Implications for preventive intervention are discussed.

Impulsivity and the association between the feedback-related negativity and performance on an inhibitory control task in young at-risk children

Identifying neurocognitive processes associated with effective inhibitory control is particularly relevant for individuals at high risk for disruptive behaviors, such as maltreated children. Performance feedback processing during a flanker task was investigated in maltreated preschool-aged children (N = 67) via an event-related potential component, the feedback-related negativity (FRN). The functionality of the FRN in children with high impulsivity was of interest, as impulsivity was associated with an exaggerated FRN in previous research. Results showed that high impulsivity was associated with an exaggerated FRN and greater post-error slowing. For children with high impulsivity, there was a correlation between the FRN and accuracy, which was not found in children with low impulsivity. This suggests that an exaggerated FRN is particularly important for children with high impulsivity to maintain effective inhibitory control.

Foster parents' state of mind with respect to attachment: concordance with their foster children's attachment patterns at 2 and 3 years of age

The present study investigated the possible differences between foster and comparison parents' state of mind with respect to attachment, and the concordance between caregiver state of mind and child attachment classifications among 60 foster children, all placed before the age of 2 years, as well as 42 comparison children. Caregiver state of mind was measured when the children were 2 years old (Time 1) while child attachment classifications were assessed at age 2 and again at age 3 years (Time 2). The associations between foster children's attachment, age at first and final placements, number of placements, and reasons for placement also were investigated. Descriptive analyses, including cross-tabulations, and independent sample t tests were used. The results showed that the majority of the foster parents had an autonomous state of mind, and no significant group difference between foster and comparison parents was identified. At both time points, most foster children who were classified as secure had autonomous foster parents, as also was the case for the comparison children. The present results are encouraging, suggesting that placing foster children with autonomous foster parents early in life may help them to remain secure over time. Furthermore, focusing on the recruitment of autonomous foster parents is important when working with young foster children.

Diagnosing attention-deficit hyperactivity disorder (ADHD) in children involved with child protection services: are current diagnostic guidelines acceptable for vulnerable populations?

Children involved with child protection services (CPS) are diagnosed and treated for attention-deficit hyperactivity disorder (ADHD) at higher rates than the general population. Children with maltreatment histories are much more likely to have other factors contributing to behavioural and attentional regulation difficulties that may overlap with or mimic ADHD-like symptoms, including language and learning problems, post-traumatic stress disorder, attachment difficulties, mood disorders and anxiety disorders. A higher number of children in the child welfare system are diagnosed with ADHD and provided with psychotropic medications under a group care setting compared with family-based, foster care and kinship care settings. However, children's behavioural trajectories change over time while in care. A reassessment in the approach to ADHD-like symptoms in children exposed to confirmed (or suspected) maltreatment (e.g. neglect, abuse) is required. Diagnosis should be conducted within a multidisciplinary team and practice guidelines regarding ADHD diagnostic and management practices for children in CPS care are warranted both in the USA and in Canada. Increased education for caregivers, teachers and child welfare staff on the effects of maltreatment and often perplexing relationship with ADHD-like symptoms and co-morbid disorders is also necessary. Increased partnerships are needed to ensure the mental well-being of children with child protection involvement.

Review: Adoption, fostering, and the needs of looked-after and adopted children

BACKGROUND

This review of the literature examines adoption, fostering, and the needs of looked-after and adopted children. Three domains of research about looked-after children are examined.

FINDINGS

There is extensive evidence that early adverse experiences affect psychological and neurobiological development in looked-after and adopted children. There is also evidence that some looked-after and adopted children show remarkable resilience in the face of adversity; intervention research provides evidence of the ability to reduce risks and promote positive outcomes in this population. The intervention studies have revealed not only the potential for improved behavioral trajectories but also the plasticity of neurobiological systems affected by early stress.

CONCLUSION

Foster and adopted children face many challenges, but scientific knowledge also provides reason for hope and information about how to maximize positive outcomes.