The preterm infant-parent programme for attachment-PIPPA Study: a randomised controlled trial.

Background: There is increasing recognition of adverse mental health consequences of preterm birth and the impact on social-emotional development. However, the quality of the developing parent-infant relationship may be protective, with enhanced maternal sensitivity to infants' cues associated with improved outcomes.

Methods: Eighty mothers and their preterm infants born <32 weeks gestation were randomised to intervention and standard care groups.

A neurogenetics approach to defining differential susceptibility to institutional care.

An individual's neurodevelopmental and cognitive sequelae to negative early experiences may, in part, be explained by genetic susceptibility. We examined whether extreme differences in the early caregiving environment, defined as exposure to severe psychosocial deprivation associated with institutional care compared to normative rearing, interacted with a biologically informed genoset comprising (rs6265), (rs4680), and (rs3758391) to predict distinct outcomes of neurodevelopment at age 8 ( = 193, 97 males and 96 females). Ethnicity was categorized as Romanian (71%), Roma (21%), unknown (7%), or other (1%).

Serotonin transporter linked polymorphic region (5-HTTLPR) genotype moderates the longitudinal impact of early caregiving on externalizing behavior.

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.

Adoptive parents can be unprepared for the challenges in caring for children with reactive attachment disorder.

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.

Indiscriminate behaviors in previously institutionalized young children.

Objective: 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.

Methods: 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.

A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder.

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 changes 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.

Recovering from early deprivation: attachment mediates effects of caregiving on psychopathology.

Objective: Children exposed to early institutional rearing are at risk for developing psychopathology. The present investigation examines caregiving quality and the role of attachment security as they relate to symptoms of psychopathology in young children exposed to early institutionalization.

Method: Participants were enrolled in the Bucharest Early Intervention Project (BEIP), a longitudinal intervention study of children abandoned and placed in institutions at or shortly after birth.

Genetic sensitivity to the caregiving context: the influence of 5httlpr and BDNF val66met on indiscriminate social behavior.

Evidence that gene×environment interactions can reflect differential sensitivity to the environmental context, rather than risk or resilience, is increasing. To test this model, we examined the genetic contribution to indiscriminate social behavior, in the setting of a randomized controlled trial of foster care compared to institutional rearing. Children enrolled in the Bucharest Early Intervention Project (BEIP) were assessed comprehensively before the age of 30 months and subsequently randomized to either care as usual (CAUG) or high quality foster care (FCG).

Validity of evidence-derived criteria for reactive attachment disorder: indiscriminately social/disinhibited and emotionally withdrawn/inhibited types.

Objective: This study examined the validity of criteria for indiscriminately social/disinhibited and emotionally withdrawn/inhibited reactive attachment disorder (RAD).

Method: As part of a longitudinal intervention trial of previously institutionalized children, caregiver interviews and direct observational measurements provided continuous and categorical data used to examine the internal consistency, criterion validity, construct validity, convergent and discriminant validity, association with functional impairment, and stability of these disorders over time.

Results: As in other studies, the findings showed distinctions between the two types of RAD.

Stereotypies in children with a history of early institutional care.

Objectives: To investigate the prevalence of stereotypies in children with a history of early institutional care, evaluate the efficacy of a foster care intervention compared with institutional care on the course of stereotypies, and describe correlates in language, cognition, and anxiety for children who exhibit stereotypies.

Design: Randomized controlled trial.

Setting: Institutions in Bucharest, Romania.

Modification of depression by COMT val158met polymorphism in children exposed to early severe psychosocial deprivation.

Objective: To examine the impact of the catechol-O-methyltransferase (COMT) val(158)met allele on depressive symptoms in young children exposed to early severe social deprivation as a result of being raised in institutions.

Methods: One hundred thirty six children from the Bucharest Early Intervention Project (BEIP) were randomized before 31 months of age to either care as usual (CAU) in institutions or placement in newly created foster care (FCG). At 54 months of age, a psychiatric assessment using the Preschool Age Psychiatric Assessment (PAPA) was completed.

Growth and associations between auxology, caregiving environment, and cognition in socially deprived Romanian children randomized to foster vs ongoing institutional care.

Objectives: To determine effects of improved nurturing compared with institutional care on physical growth and to investigate the association between growth and cognitive development.

Design: A randomized controlled trial beginning in infants (mean age, 21.0 months; range, 5-32 months), with follow-up at 30, 42, and 54 months of age.

Placement in foster care enhances quality of attachment among young institutionalized children.

This study examined classifications of attachment in 42-month-old Romanian children (N = 169). Institutionalized since birth, children were assessed comprehensively, randomly assigned to care as usual (CAU) or to foster care, and compared to family-reared children. Attachment classifications for children in foster care were markedly different from those in the CAU.

Institutional rearing and psychiatric disorders in Romanian preschool children.

Objective: There is increasing interest in the relations between adverse early experiences and subsequent psychiatric disorders. Institutional rearing is considered an adverse caregiving environment, but few studies have systematically examined its effects. This study aimed to determine whether removing young children from institutional care and placing them with foster families would reduce psychiatric morbidity at 54 months of age.

A new model of foster care for young children: the Bucharest early intervention project.

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.

The effects of foster care intervention on socially deprived institutionalized children's attention and positive affect: results from the BEIP study.

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.

Attachment disorders in family and social context.

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.

Predictors of permanent loss of custody for mothers of infants and toddlers in foster care.

The maltreating mothers of abused and neglected infants and toddlers were evaluated as part of an intensive intervention program. The purpose of this study was to examine cumulative risk versus specific risk factors that led to permanent loss of custody by mothers, predicated upon decisions by the Juvenile Court with regard to permanency planning. The following risk factors were analyzed as potential predictors of placement outcomes: maternal education, maternal history of abuse as a child, history of psychiatric difficulties, substance-abuse history, conviction history (excluding child-abuse charges), depressive symptomatology, degree of partner violence experienced, and cumulative number of risks the mother experienced.

Cognitive recovery in socially deprived young children: the Bucharest Early Intervention Project.

In a randomized controlled trial, we compared abandoned children reared in institutions to abandoned children placed in institutions but then moved to foster care. Young children living in institutions were randomly assigned to continued institutional care or to placement in foster care, and their cognitive development was tracked through 54 months of age. The cognitive outcome of children who remained in the institution was markedly below that of never-institutionalized children and children taken out of the institution and placed into foster care.

The caregiving context in institution-reared and family-reared infants and toddlers in Romania.

Background: We assess individual differences in the caregiving environments of young children being raised in institutions in Romania in relation to developmental characteristics such as physical growth, cognitive development, emotional expression, and problem and competence behaviors.

Method: Videotaped observations of the child and favorite caregiver in their 'home' environment were coded for caregiving quality, and this was related to child characteristics. Child emotional reactivity was assessed during responses to interactional tasks.

Attachment in institutionalized and community children in Romania.

This study examined attachment in institutionalized and community children 12-31 months of age in Bucharest, Romania. Attachment was assessed using ratings of attachment behaviors and ratings of caregiver descriptions in a structured interview. As predicted, children raised in institutions exhibited serious disturbances of attachment as assessed by all methods.

Reactive attachment disorder in maltreated toddlers.

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.

Comparing criteria for attachment disorders: establishing reliability and validity in high-risk samples.

Objective: To determine whether published subtypes of attachment disorder can be reliably identified by trained clinicians reviewing data from high-risk populations and to investigate the relationship between disorder classification and standardized measures of attachment behavior.

Method: Twenty or more children aged 18 to 48 months and their primary caregivers were recruited from three sites: a treatment team for maltreated young children (n = 20), a homeless shelter (n = 25), and Head Start centers (n = 24). All dyads completed a semistructured clinical assessment and laboratory and home-based attachment measures.

Designing research to study the effects of institutionalization on brain and behavioral development: the Bucharest Early Intervention Project.

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.