Effect of Foster Care Intervention on Trajectories of General and Specific Psychopathology Among Children With Histories of Institutional Rearing

Abstract

IMPORTANCE It is unclear whether early institutional rearing is associated with more problematic trajectories of psychopathology from childhood to adolescence and whether assignment to foster care mitigates this risk. OBJECTIVES To examine trajectories of latent psychopathology factors-general (P), internalizing (INT), and externalizing (EXT)-among children reared in institutions and to evaluate whether randomization to foster care is associated with reductions in psychopathology from middle childhood through adolescence. DESIGN, SETTING, AND PARTICIPANTS This longitudinal, intent-to-treat randomized clinical trial was conducted in Bucharest, Romania, where children residing in 6 institutions underwent baseline testing and were then randomly assigned to a care as usual group (CAUG) or a foster care group (FCG). A matched sample of a never-institutionalized group (NIG) was recruited to serve as a comparison group. The study commenced in April 2001, and the most recent (age 16 years) follow-up started in January 2015 and is ongoing. INTERVENTION Institutionally reared children randomized to high-quality foster homes. MAIN OUTCOMES AND MEASURES Psychopathology was measured using the MacArthur Health and Behavior Questionnaire. Teachers and/or caregivers reported on symptoms of psychopathology in several domains. RESULTS A total of 220 children (50.0% female; 119 ever institutionalized) were included in the analysis at the mean ages of 8, 12, and 16 years. A latent bifactor model with general (P) and specific internalizing (INT) and externalizing (EXT) factors offered a good fit to the data. At age 8 years, CAUG (mean, 0.41; 95% CI, 0.17-0.67) and FCG (mean, 0.30; 95% CI, 0.04-0.53) had higher P than NIG (mean, −0.40; 95% CI, −0.56 to −0.18). By age 16 years, FCG (mean, 0.07; 95% CI, −0.18 to 0.29) had lower P than CAUG (mean, 0.37; 95% CI, 0.13-0.60). This effect was likely driven by modest declines in P from age 8 years to age 16 years among FCG (slope, −0.12; 95% CI, −0.26 to 0.04) compared with CAUG, who remained stably high over this period (slope, −0.02; 95% CI, −0.19 to 0.14). Moreover, CAUG and FCG showed increasing divergence in EXT over time, such that FCG (mean, −0.30; 95% CI, −0.58 to −0.02) had fewer problems than CAUG (mean, 0.05; 95% CI, −0.25 to 0.36) by age 16 years. No INT differences were observed. CONCLUSIONS AND RELEVANCE Institutionalization increases transdiagnostic vulnerability to psychopathology from childhood to adolescence, a period of significant social and biological change. Early assignment to foster care partially mitigates this risk, thus highlighting the importance of social enrichment in buffering the effects of severe early neglect on trajectories of psychopathology. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00747396

Stress sensitization among severely neglected children and protection by social enrichment

“…This suggests that the foster care children may be more responsive to the higher quality care they receive, and this higher quality care may be protective against later stressful life events. In turn, this may help to explain the lower levels of externalizing problems observed between these groups at age 16 5 . Future studies can help to determine whether the putative buffering effect of higher caregiving quality operates through its influence on stress system development and emerging self-regulatory abilities in childhood and adolescence.…”

“…This is especially important in the context of institutional rearing, as externalizing problems appear more responsive to foster care intervention following institutional care than internalizing problems 2 . Also, after controlling for overlap with other domains of psychopathology, externalizing problems decline over the transition to adolescence among children in foster care, while those with prolonged institutional deprivation show persistent difficulties over this period 5 . This same pattern is not observed for internalizing problems.…”

“…Among children experiencing profound neglect in the context of institutional rearing, higher rates of both internalizing and externalizing disorders are observed across development 2,3 . The causal impact of neglect on psychopathology is highlighted by the finding that institutionally-reared children who are randomly assigned to foster care early in life have lower internalizing and externalizing problems 2,4 , and lower general psychopathology risk 5 , compared with children experiencing prolonged institutional rearing.…”

White matter microstructure correlates of general and specific second-order factors of psychopathology

“…By contrast, the present study applied a bifactor model that allows for a transdiagnostic quantitative approach to distinguish between different second-order dimensions of psychopathology. While there are methodological limitations when using fit statistics to adjudicate between bifactor and traditional correlated factor models of psychopathology, increasing data indicate the ability of this approach to differentiate meaningful nonspecific and dimension-specific correlates of psychopathology including etiological, concurrent and predictive correlates (Caspi and Moffitt, 2018; Lahey et al, 2017b; Wade et al, 2018). Importantly, in the present study, we identified both broad nonspecific (FA in the body of the CC) and second-order externalizing or internalizing level dimensions (AD in the fornix, sagittal stratum, anterior corona radiata, and splenium of the CC) white matter correlates of psychopathology.…”

White Matter Microstructure Correlates of General and Specific Second-Order Factors of Psychopathology

“…By contrast, the present study applied a bifactor model that allows for a transdiagnostic quantitative approach to distinguish between different second-order dimensions of psychopathology. While there are methodological limitations when using fit statistics to adjudicate between bifactor and traditional correlated factor models of psychopathology, increasing data indicate the ability of this approach to differentiate meaningful nonspecific and dimension-specific correlates of psychopathology including etiological, concurrent and predictive correlates Lahey et al, 2017a;Wade et al, 2018). Importantly, in the present study, we identified both nonspecific (FA in the body of the CC) and specific (AD in the fornix, sagittal stratum, anterior corona radiata, and splenium of the CC) white matter correlates of psychopathology.…”