A Randomized Controlled Trial Comparing Foster Care and Institutional Care for Children With Signs of Reactive Attachment Disorder

Abstract

Objective The authors examined signs of emotionally withdrawn (inhibited type) and indiscriminately social (disinhibited type) reactive attachment disorder in Romanian children enrolled in a randomized trial of foster care compared with institutional care and in a comparison group of never-institutionalized children. Method At baseline and when children were ages 30, 42, and 54 months and 8 years, caregivers were interviewed with the Disturbances of Attachment Interview to assess changed in signs of reactive attachment disorder in three groups of children: those receiving care as usual (including continued institutional care) (N=68); those placed in foster care after institutional care (N=68), and those who were never institutionalized (N=72). The impact of gender, ethnicity, and baseline cognitive ability was also examined. Results On the Disturbances of Attachment Interview, signs of the inhibited type of reactive attachment disorder decreased after placement in foster care, and scores were indistinguishable from those of never-institutionalized children after 30 months. Signs of the disinhibited type were highest in the usual care group, lower in the foster care group, and lowest in the never-institutionalized group. Early placement in foster care (before age 24 months) was associated with fewer signs of the disinhibited type. Lower baseline cognitive ability was associated with more signs of the inhibited type in the usual care group and more signs of the disinhibited type in both groups. Conclusions Signs of the inhibited type of reactive attachment disorder responded quickly to placement in foster care; signs of the disinhibited type showed less robust resolution with foster placement. Lower baseline cognitive ability was linked to signs of reactive attachment disorder.

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

“…This score indicates the extent to which the child distinguishes adults, manifests a clear preference for a particular caregiver, seeks and responds to comfort from a specific caregiver when distressed, and evinces problems with reciprocal social exchanges and emotion regulation. In our sample, the mean score was 2.1, similar to scores found in previous studies (Smyke et al, 2012;Zeanah et al, 2005). Inter-rater agreement for this subscale was very good (ICC ric = .92).…”

“…Notably, evidence further indicates that once institutionalized children are placed in foster or adoptive families and receive adequate care, signs of IADB diminish substantially, in fact, disappearing entirely in most cases (O'Connor, Bredenkamp, & Rutter, 1999;Smyke et al, 2012). Perhaps more than anything, such results underscore the importance of relational experience in the etiology of IADB (Zeanah & Gleason, 2015).…”

Indiscriminate Behaviors in Previously Institutionalized Young Children

“…This lack of a robust intervention effect is consistent with studies that demonstrate persistence of indiscriminate behavior over time despite placement in adequate caregiving situations. 3,10 Novel interventions are needed to accelerate recovery from deprivationrelated indiscriminate social behaviors. The study design allowed detailed examination of the role of caregiving in young children with a history of institutional care and subsequent indiscriminate social behaviors.…”

Effects of early intervention and the moderating effects of brain activity on institutionalized children's social skills at age 8

“…Many studies have characterized children's attachment relationships formed with institutional (13,14), adoptive (15), or foster (16,17) caregivers. These studies have documented profound problems in the attachment relationships that young children form with caregivers following early deprivation.…”