In the Journals

Early foster care intervention lessens risk for psychopathology in children

Youth with a history of institutional rearing assigned to early foster care intervention had less problematic trajectories of psychopathology from childhood to adolescence, study findings revealed.

“Early foster care placement has been shown to partially mitigate the negative psychiatric outcomes of institutionally reared children,” Mark Wade, PhD, division of developmental medicine, Boston Children’s Hospital, Harvard Medical School, and colleagues wrote. “Little is known about the mental health trajectories of institutionalized children, in part because there are so few longitudinal studies in this field.”

In this longitudinal, intent-to-treat randomized clinical study, researchers evaluated the trajectories of latent psychopathology factors — general, internalizing and externalizing — among children with a history of institutional rearing. They also examined whether randomization to foster care was tied to reductions in psychopathology from age 8 years through adolescence.

Children from Romania residing in six institutions underwent baseline testing and then were randomly allocated to a care as usual group or a foster care group. A matched sample of never-institutionalized children served as the comparison group. Participants were followed up at 8, 12 and 16 years. Wade and colleagues examined participants’ psychopathology via the MacArthur Health and Behavior Questionnaire and teacher/caregiver-reported symptoms.

In total, 220 children, 119 of whom had histories of institutional rearing, were included in the analysis. According to the results, children in the care as usual group and in the foster care group experienced higher general psychopathology compared with never-institutionalized children at ages 8, 12 and 16 years.

The care as usual and foster care groups did not differ on their level of general psychopathology at age 8 years; however, differences started emerging by age 12 years. By age 16 years, children in the foster care group had significantly lower general psychopathology factors than those in the care as usual group. Wade and colleagues indicated that these group differences were likely driven by the finding that foster care children showed modest declines in general psychopathology from age 8 years to age 16 years, while care as usual children remained high.

Although the care as usual and foster care groups showed increasing divergence in externalizing psychopathology factors over time, demonstrating that the foster care intervention lead to fewer problems than care as usual by age 16 years, the results showed no internalizing differences.

“This study provides strong evidence that the beneficial effects of foster care grow incrementally over time and may promote healthy adaptation during a formative period of neurophysiological reorganization,” the investigators wrote. “Elucidating how these neurophysiological systems map onto long-term trajectories of psychopathology is a crucial area for future research.”

The results presented by Wade and colleagues support the importance of early interventions for institutionalized children, Jonathan D. Schaefer, MA, from the department of psychology and neuroscience, Duke University, wrote in an accompanying editorial.

“Their results also underscore the notion that hierarchical models of psychopathology will continue to be important organizing structures in understanding not only patterns of comorbidity among disorders, but also how the liability to these conditions is shaped by environmental influences,” Schaefer concluded. – by Savannah Demko

Disclosures: Wade reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Schaefer reports support from the National Institute on Aging and the National Institute of Child Health and Human Development.

Youth with a history of institutional rearing assigned to early foster care intervention had less problematic trajectories of psychopathology from childhood to adolescence, study findings revealed.

“Early foster care placement has been shown to partially mitigate the negative psychiatric outcomes of institutionally reared children,” Mark Wade, PhD, division of developmental medicine, Boston Children’s Hospital, Harvard Medical School, and colleagues wrote. “Little is known about the mental health trajectories of institutionalized children, in part because there are so few longitudinal studies in this field.”

In this longitudinal, intent-to-treat randomized clinical study, researchers evaluated the trajectories of latent psychopathology factors — general, internalizing and externalizing — among children with a history of institutional rearing. They also examined whether randomization to foster care was tied to reductions in psychopathology from age 8 years through adolescence.

Children from Romania residing in six institutions underwent baseline testing and then were randomly allocated to a care as usual group or a foster care group. A matched sample of never-institutionalized children served as the comparison group. Participants were followed up at 8, 12 and 16 years. Wade and colleagues examined participants’ psychopathology via the MacArthur Health and Behavior Questionnaire and teacher/caregiver-reported symptoms.

In total, 220 children, 119 of whom had histories of institutional rearing, were included in the analysis. According to the results, children in the care as usual group and in the foster care group experienced higher general psychopathology compared with never-institutionalized children at ages 8, 12 and 16 years.

The care as usual and foster care groups did not differ on their level of general psychopathology at age 8 years; however, differences started emerging by age 12 years. By age 16 years, children in the foster care group had significantly lower general psychopathology factors than those in the care as usual group. Wade and colleagues indicated that these group differences were likely driven by the finding that foster care children showed modest declines in general psychopathology from age 8 years to age 16 years, while care as usual children remained high.

Although the care as usual and foster care groups showed increasing divergence in externalizing psychopathology factors over time, demonstrating that the foster care intervention lead to fewer problems than care as usual by age 16 years, the results showed no internalizing differences.

“This study provides strong evidence that the beneficial effects of foster care grow incrementally over time and may promote healthy adaptation during a formative period of neurophysiological reorganization,” the investigators wrote. “Elucidating how these neurophysiological systems map onto long-term trajectories of psychopathology is a crucial area for future research.”

The results presented by Wade and colleagues support the importance of early interventions for institutionalized children, Jonathan D. Schaefer, MA, from the department of psychology and neuroscience, Duke University, wrote in an accompanying editorial.

“Their results also underscore the notion that hierarchical models of psychopathology will continue to be important organizing structures in understanding not only patterns of comorbidity among disorders, but also how the liability to these conditions is shaped by environmental influences,” Schaefer concluded. – by Savannah Demko

Disclosures: Wade reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Schaefer reports support from the National Institute on Aging and the National Institute of Child Health and Human Development.