High-Quality Foster Care Mitigates Callous-Unemotional Traits Following Early Deprivation in Boys: A Randomized Controlled Trial

Abstract

Objective Callous-unemotional (CU) traits in childhood are a developmental precursor to psychopathy, yet the origins and etiology of CU traits are not known. We examined CU traits among 12-year-old children exposed to severe early deprivation and evaluated whether a high-quality foster care intervention mitigated the development of high levels of CU traits. Method Participants were from the Bucharest Early Intervention Project, a randomized controlled trial of foster care for children in institutions. Children were recruited from institutions in Bucharest, Romania, along with age-and sex-matched children who were never institutionalized. Children raised in institutional settings were randomized (meanage = 22 months) to either a foster care group (n = 68) or a care-as-usual group (n = 68). CU traits were assessed at age 12.75 years in available participants from the randomized trial (n = 95) and children who were never institutionalized (n = 50). Results Children who experienced institutional rearing as young children had significantly higher levels of CU traits in early adolescence compared to children who were never institutionalized. Intent-to-treat analysis indicated that, among boys, CU traits were significantly lower among those who received the foster care intervention compared to those randomized to care as usual. Caregiver responsiveness to distress, but not caregiver warmth, mediated the intervention effect on CU traits in boys. Conclusion These findings provide the first evidence to date that psychosocial intervention can prevent the onset of CU traits. Although severe early deprivation predicted higher levels of CU traits, high-quality foster care that emphasized responsive caregiving reduced the impact of deprivation on CU trait development for boys. Clinical trial registration information The Bucharest Early Intervention Project; http://clinicaltrials.gov; NCT00747396.

Maternal sensitivity to distress, attachment and the development of callous-unemotional traits in young children

“…The findings are consistent with work with older children suggesting that parental responsiveness to distress may play a role in child empathy development (Davidov & Grusec, 2000;Humphreys et al, 2015). The findings are also consistent with the broader literature documenting associations between positive aspects of parenting and CU traits from the preschool period through to late childhood (e.g.…”

“…In a cross-sectional study of 6-8 year olds, higher maternal sensitivity to distress, but not warmth, was associated with increased child empathy. In a randomized controlled trial of the effect of foster care in children experiencing early institutional deprivation, observed sensitivity to distress, but not warmth, assessed at 30 and 42 months of age, predicted lower CU traits in early adolescence (Humphreys et al, 2015).…”

Caregiving Disruptions Affect Growth and Pubertal Development in Early Adolescence in Institutionalized and Fostered Romanian Children: A Randomized Clinical Trial

“…This finding extends the number of sex-related differences in the response to adversity or the foster care intervention documented in BEIP. 42–44 Boys in institutionalized group with ≥2 caregiving disruptions had lower mean Tanner scores at 12 years of age vs institutionalized group and foster care group boys with <2 disruptions. Girls in foster care group who experienced ≥2 caregiving disruptions had greater mean Tanner scores at 14 years of age than foster care group girls experiencing <2 caregiving disruptions.…”

The Effects of Psychosocial Deprivation on Attachment: Lessons from the Bucharest Early Intervention Project

“…For example, security of attachment at 42 months among children with histories of institutional rearing predicted reductions in internalizing signs in girls at 54 months, sustained levels of stable, typical IQ scores through age 12 years (Almas et al, 2016), social skills at 8 years (Almas et al, 2012), a reduction in callous unemotional traits in boys at 12 years (Humphreys, McGoron et al, 2015), and overall competence at 12 years (Humphreys, Miron, McLaughlin, Sheridan, Nelson, Fox, & Zeanah, under review). …”

“…Finally, response to distress at age 42 months was associated with reductions in callous unemotional traits. Security of attachment also mediated the effects of response to distress on reducing callous unemotional traits in early adolescent boys (Humphreys, McGoron et al, 2015). …”