To determine whether signs of disordered attachment were greater in young children being reared in more socially depriving caregiving environments.
Three groups of children were studied by means of ...structured interviews with caregivers that were administered over several months in Bucharest, Romania, in 1999: (1) 32 toddlers living in a typical unit (standard care) in a large institution in Bucharest; (2) 29 toddlers living in the same institution on a 'pilot unit" designed to reduce the number of adults caring for each child; and (3) 33 toddlers living at home who had never been institutionalized. The presence of attachment disorders and other behavioral problems was assessed by caregiver/ parent report.
Children on the typical unit (standard care) had significantly more signs of disordered attachment than children in the other two groups. Both the emotionally withdrawn and the indiscriminately social pattern of attachment disorder were apparent in these children, but cluster analysis suggested that mixed patterns are more typical.
The continuum of caretaking casualty is reflected by increasing signs of disordered attachment in toddlers living in more socially depriving environments.
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.
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.
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 (ExpB = 1.6 95% confidence interval: 1.1-2.5).
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.
This paper provides an overview of the largest longitudinal investigation of institutionalized children less than 2 years old ever conducted. The Bucharest Early Intervention Project is an ongoing ...randomized controlled trial of foster placement as an alternative to institutionalization in abandoned infants and toddlers being conducted in Bucharest, Romania. In addition to describing the contexts in which this study is imbedded, we also provide an overview of the sample, the measures, and the intervention. We hope that the natural experiment of institutionalization will allow us to examine directly the effects of intervention on early deprivation. We hope it will provide answers to many of the critical questions that developmentalists have asked about the effects of early experience, the timing of deprivation, and the ameliorating effects of early intervention and provide clues to which underlying neurobiological processes are compromised by, and resilient to, dramatic changes in early experience.
We examined caregiver report of externalizing behavior from 12 to 54 months of age in 102 children randomized to care as usual in institutions or to newly created high-quality foster care. At ...baseline no differences by group or genotype in externalizing were found. However, changes in externalizing from baseline to 42 months of age were moderated by the serotonin transporter linked polymorphic region genotype and intervention group, where the slope for short-short (S/S) individuals differed as a function of intervention group. The slope for individuals carrying the long allele did not significantly differ between groups. At 54 months of age, S/S children in the foster care group had the lowest levels of externalizing behavior, while children with the S/S genotype in the care as usual group demonstrated the highest rates of externalizing behavior. No intervention group differences were found in externalizing behavior among children who carried the long allele. These findings, within a randomized controlled trial of foster care compared to continued care as usual, indicate that the serotonin transporter linked polymorphic region genotype moderates the relation between early caregiving environments to predict externalizing behavior in children exposed to early institutional care in a manner most consistent with differential susceptibility.
The Bucharest Early Intervention Project is a randomized controlled trial of foster care as an intervention for young children who have spent most of their lives in institutions in Bucharest, ...Romania. The authors implemented an attachment-based model of child-centered foster care there, and a team of three Romanian social workers trained and supported foster parents in managing the complex challenges of caring for postinstitutionalized infants and toddlers. They received regular weekly consultation from US-based clinicians designed to guide their work with foster parents and children. From language development to toilet training to encouraging the development of the young child's ability to trust, foster parents received ongoing support to help these young children transition to family life. Developmental outcomes so far indicate significantly better outcomes for young children in this foster care program than children who remained in institutions. For some domains of development, earlier placement was associated with better outcomes but for others, timing of placement did not appear to matter.
Implications for practice and research: Adoptive parents experience significant challenges in caring for children diagnosed with reactive attachment disorder. Informing prospective adoptive parents ...about attachment issues and providing concrete assistance to develop healthy attachment relationships may decrease some of the frustration experienced by parents and children affected with the disorder. Future research could address factors contributing to the diagnosis of reactive attachment disorder as well as best practices for ameliorating the disorder.
Background: We examined the effects of a foster care intervention on attention and emotion expression in socially deprived children in Romanian institutions.
Methods: Institutionalized children ...were randomized to enter foster care or to remain under institutional care. Subsequently, the institutionalized and foster care groups, along with a community‐based comparison group, were evaluated on emotion tasks at 30 and 42 months of age. Behaviors reflecting positive and negative affect and attention were coded from videotapes. Results: Data indicated that at both age points, children who received the foster care intervention showed higher levels of attention and positive affect compared to children who remained institutionalized. Compared to the community sample, children in the foster care intervention showed higher levels of attention to the emotion‐eliciting tasks at 42 months of age.
Conclusions: The results of this randomized trial demonstrate the impact of a family‐based intervention on the development of attention and positive affect.
To assess convergence among three different measures of indiscriminate behavior and to assess the relationship of indiscriminate behavior to having an attachment figure and to aggressive behavior ...among young children living in a Romanian institution.
Caregivers in the institution were interviewed with semistructured interviews regarding the behavior of 61 children with special emphasis on indiscriminate behavior. The study was conducted in Bucharest, Romania (1999).
Substantial convergence among measures of indiscriminate behavior was demonstrated. Indiscriminate behavior was common whether or not these children had a preferred attachment figure. Indiscriminate behavior was independent of aggressive behavior.
Differing explanations for indiscriminate behavior in young children derive from differing interpretations of similar findings rather than different findings with different measures. Indiscriminate behavior was largely independent of aggression in these institutionalized young children. Indiscriminate behavior may represent an independent problem rather than a type of reactive attachment disorder as suggested by DSM-IV criteria.
Serious disturbances of attachment in young children have been increasingly studied in the past decade as they arise in atypical rearing environments. The purpose of this review is to provide an ...update on recent findings and to consider their implications. Research on children raised in institutions, children adopted out of institutions, and young children who have experienced neglect in families is considered. Reactive attachment disorder may be identified reliably in a minority of children being raised in severely neglectful environments. The emotionally withdrawn/inhibited pattern and the indiscriminately social/disinhibited pattern arise in similar conditions of risk, but respond differently to intervention and appear to have different correlates. Much has been learned about the emotionally withdrawn/inhibited pattern of reactive attachment disorder and the indiscriminately social/disinhibited pattern. Much less is known about so‐called secure base distortions or relational disorders of attachment.
Objective: To determine if Reactive Attachment Disorder (RAD) can be reliably identified in maltreated toddlers in foster care, if the two types of RAD are independent, and to estimate the prevalence ...of RAD in these maltreated toddlers.
Methods: Clinicians treating 94 maltreated toddlers in foster care were interviewed regarding signs of attachment disorder at intake in an intervention program.
Results: Using categorical and continuous measures, both types of RAD can be reliably identified in maltreated toddlers. Both continuous scores and categorical diagnoses indicated that a substantial minority of maltreated young children do exhibit signs of attachment disorders sufficient to meet criteria in DSM-IV and ICD-10. The two types were moderately convergent and at times co-occurred in the same child. Prevalence of RAD in this high-risk sample was 38–40%. Indiscriminate/disinhibited RAD was identified in children with and without an attachment figure. Within this maltreated group, toddlers whose mothers had a history of psychiatric disturbance were more likely to be diagnosed with attachment disorders.
Conclusions: RAD may be reliably identified in maltreated toddlers. Emotionally withdrawn/inhibited and indiscriminate/disinhibited types of RAD are not entirely independent.
Objectif: Déterminer si les troubles réactionnels de l’attachement (RAD) peuvent être identifiés de façon sûre chez les jeunes enfants placés dans des familles d’accueil, si les deux types de RAD sont indépendants, et si l’on peut estimer la prévalence du RAD chez ces enfants maltraités.
Méthode: On a interrogé les cliniciens qui avaient en traitement 94 jeunes enfants maltraités et placés en famille d’accueil au sujet des signes de troubles de l’attachement au début d’un programme d’intervention.
Résultats: A l’aide de mesures continues et par catégorie, les deux types de RAD ont pu être identifiés de façon sûre chez les jeunes enfants maltraités. A la fois les scores continus et les diagnostics par catégorie ont indiqué qu’une minorité importante de jeunes enfants maltraités montrait des troubles de l’attachement suffisants pour correspondre aux critères DSM-IV et ICD-I0. Les deux types convergeaients modérément et parfois étaient présents en même temps chez le même enfant. La prévalence de RAD chez cet échantillon à haut risque était de 38 à 40%. On a identifié un RAD indistinct ou peu présent chez des enfants ayant ou n’ayant pas une figure d’attachement. A l’intérieur de ce groupe maltraité, les jeunes enfants dont la mère avait un passé posychiâtrique étaient le plus susceptibles d’être diagnostiqués comme présentant des troubles de l’attachement.
Conclusion: On peut identifié de façon fiable le RAD chez les jeunes enfants maltraités. Les types de RAD comportant retrait et inhibition ainsi que absence de distinction et d’inhibition ne sont pas entièrement indépendants.
Objetivo: Determinar si el Desorden del Apego Reactivo (RAD) puede identificarse con confiabilidad en los niños maltratados en cuidado sustituto, si los dos tipos de RAD son independientes, y estimar la prevalencia de RAD en estos niños maltratados.
Métodos: Se entrevistaron los clínicos que atendían a 94 niños maltratados en cuidado sustituto en relación a señales de desorden del apego al registrarlos en un programa de intervención.
Resultados: Utilizando medidas categóricas y contínuas, ambos tipos de RAD pueden ser identificados con confiabilidad en los niños maltratados. Tanto los puntajes contínuos y los diagnósticos categóricos indicaron que una minoría substancial de los niños pequeños maltratados si exhiben señales de desórdenes del apego suficientes para confirmar los criterios en el DSM-IV y el ICD-10. Los dos tipos fueron moderadamente convergentes y en algunos momentos co-ocurrentes en el mismo niño. La prevalencia de RAD en esta muestra de alto riesgo fue de 38–40%. RAD indiscriminado/desinhibido fue identificado en niños con y sin una figura de apego. En este grupo de maltrato, los niños cuyas madres tenían una historia de perturbaciones psiquiátricas tenían mayor probabilidad de ser diagnosticados con desórdenes del apego.
Conclusiones: El RAD puede ser diagnosticado con confiabilidad en los niños maltratados. Los tipos de RAD emocionalmente reservado/inhibido y indiscriminado/desinhibido no son completamente independientes.
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