Restricted accessResearch articleFirst published online 2021-9
Growth in Self-Regulation Over the Course of Adolescence Mediates the Effects of Foster Care on Psychopathology in Previously Institutionalized Children: A Randomized Clinical Trial
Children reared in institutions experience severe psychosocial deprivation, resulting in lasting consequences for social and emotional development. This study evaluated growth trajectories of self-regulation from ages 8 to 16 among previously institutionalized children randomized to foster care (foster-care group; FCG) or to remain in institutional care (care-as-usual group; CAUG) compared with a never-institutionalized group (NIG). We then tested a developmental pathway by which growth in self-regulation reduces general psychopathology at age 16 for the FCG relative to the CAUG. The FCG experienced modest growth in self-regulation over adolescence and “caught up” to the NIG by age 16. The beneficial effect of foster care on psychopathology operated through growth in self-regulation; part of this effect was further mediated by reduced peer difficulties for the FCG. Findings reveal that the effects of foster care on self-regulation emerge over adolescence and that growth in self-regulation is a mechanism by which foster care mitigates the impact of institutionalization on psychopathology.
AblowJ. C.MeaselleJ. R.KraemerH. C.HarringtonR.LubyJ.SmiderN.DierkerL.ClarkV.DubickaB.HeffelfingerA.EssexM. J.KupferD. J. (1999). The MacArthur three-city outcome study: Evaluating multi-informant measures of young children’s symptomatology. Journal of the American Academy of Child and Adolescent Psychiatry, 38(12), 1580–1590. https://doi.org/10.1097/00004583-199912000-00020
2.
AinsworthM. D. S.BellS. M.StaytonD. F. (1974). Infant-mother attachment and social development: Socialization as a product of reciprocal responsiveness to signals. In RichardsM. P. M. (Ed.)., The integration of a child into a social world (pp. 99–135). Cambridge University Press.
3.
AlmasA. N.DegnanK. A.RadulescuA.NelsonC. A.ZeanahC. H.FoxN. A. (2012). Effects of early intervention and the moderating effects of brain activity on institutionalized children’s social skills at age 8. Proceedings of the National Academy of Sciences, USA, 109(Suppl. 2), 17228–17231. https://doi.org/10.1073/pnas.1121256109
4.
AlmasA. N.DegnanK. A.WalkerO. L.RadulescuA.NelsonC. A.ZeanahC. H.FoxN. A. (2015). The effects of early institutionalization and foster care intervention on children’s social behaviors at the age of eight. Social Development, 24(2), 225–239. https://doi.org/10.1111/sode.12089
5.
AlmasA. N.PappL. J.WoodburyM. R.NelsonC. A.ZeanahC. H.FoxN. A. (2020). The impact of caregiving disruptions of previously institutionalized children on multiple outcomes in late childhood. Child Development, 91(1), 96–109. https://doi.org/10.1111/cdev.13169
6.
BerensA. E.NelsonC. A. (2015). The science of early adversity: Is there a role for large institutions in the care of vulnerable children?The Lancet, 386(9991), 388–398. https://doi.org/10.1016/S0140-6736(14)61131-4
7.
BlairB. L.PerryN. B.O’BrienM.CalkinsS. D.KeaneS. P.ShanahanL. (2014). The indirect effects of maternal emotion socialization on friendship quality in middle childhood. Developmental Psychology, 50(2), 566–576. https://doi.org/10.1037/a0033532
8.
BloemenA. J. P.OldehinkelA. J.LaceulleO. M.OrmelJ.RommelseN. N. J.HartmanC. A. (2018). The association between executive functioning and psychopathology: General or specific?Psychological Medicine, 48(11), 1787–1794. https://doi.org/10.1017/S0033291717003269
9.
CaprinC.BenedanL.BallarinL.GallaceA. (2017). Social competence in Russian post-institutionalized children: A comparison of adopted and non-adopted children. Children and Youth Services Review, 75, 61–68. https://doi.org/10.1016/j.childyouth.2017.02.020
10.
CaseyB. J.JonesR. M.SomervilleL. H. (2011). Braking and accelerating of the adolescent brain. Journal of Research on Adolescence, 21(1), 21–33. https://doi.org/10.1111/j.1532-7795.2010.00712.x
11.
CaspiA.HoutsR. M.BelskyD. W.Goldman-MellorS. J.HarringtonH.IsraelS.MeierM. H.RamrakhaS.ShalevI.PoultonR.MoffittT. E. (2014). The p factor: One general psychopathology factor in the structure of psychiatric disorders?Clinical Psychological Science, 2(2), 119–137. https://doi.org/10.1177/2167702613497473
12.
Castellanos-RyanN.BrièreF. N.O’Leary-BarrettM.BanaschewskiT.BokdeA.BrombergU.BüchelC.FlorH.FrouinV.GallinatJ.GaravanH.MartinotJ. L.NeesF.PausT.PausovaZ.RietschelM.SmolkaM. N.RobbinsT. W.WhelanR., . . . IMAGEN Consortium. (2016). The structure of psychopathology in adolescence and its common personality and cognitive correlates. Journal of Abnormal Psychology, 125(8), 1039–1052. https://doi.org/10.1037/abn0000193
13.
ChisholmK. (1998). A three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages. Child Development, 69(4), 1092–1106. https://doi.org/10.2307/1132364
14.
ColvertE.RutterM.BeckettC.CastleJ.GroothuesC.HawkinsA.KreppnerJ.O’connorT. G.StevensS.Sonuga-BarkeE. J. S. (2008). Emotional difficulties in early adolescence following severe early deprivation: Findings from the English and Romanian adoptees study. Development and Psychopathology, 20(2), 547–567. https://doi.org/10.1017/S0954579408000278
15.
CoyneM. A.WrightJ. P. (2014). The stability of self-control across childhood. Personality and Individual Differences, 69, 144–149. https://doi.org/10.1016/j.paid.2014.05.026
16.
DaviesP. T.CicchettiD. (2004). Toward an integration of family systems and developmental psychopathology approaches. Development and Psychopathology, 16(3), 477–481. https://doi.org/10.1017/s0954579404004626
17.
DuckworthA. L.KimB.TsukayamaE. (2012). Life stress impairs self-control in early adolescence. Frontiers in Psychology, 3, Article 608. https://doi.org/10.3389/fpsyg.2012.00608
18.
EndersC. K.BandalosD. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8(3), 430–457. https://doi.org/10.1207/S15328007SEM0803_5
19.
EssexM. J.BoyceW. T.GoldsteinL. H.ArmstrongJ. M.KraemerH. C.KupferD. J. (2002). The confluence of mental, physical, social, and academic difficulties in middle childhood. II: Developing the MacArthur Health and Behavior Questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry, 41(5), 588–603. https://doi.org/10.1097/00004583-200205000-00017
20.
EtelE.YagmurluB. (2015). Social competence, theory of mind, and executive function in institution-reared Turkish children. International Journal of Behavioral Development, 39(6), 519–529. https://doi.org/10.1177/0165025414556095
21.
FeldmanR.EidelmanA. I. (2009). Biological and environmental initial conditions shape the trajectories of cognitive and social-emotional development across the first years of life. Developmental Science, 12(1), 194–200. https://doi.org/10.1111/j.1467-7687.2008.00761.x
22.
FeldmanR.GreenbaumC. W.YirmiyaN. (1999). Mother-infant affect synchrony as an antecedent of the emergence of self-control. Developmental Psychology, 35(1), 223–231. https://doi.org/10.1037/0012-1649.35.1.223
23.
FergussonD. M.BodenJ. M.HorwoodL. J. (2013). Childhood self-control and adult outcomes: Results From a 30-year longitudinal study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 709–717.e1. https://doi.org/10.1016/j.jaac.2013.04.008
24.
FoxN. A.AlmasA. N.DegnanK. A.NelsonC. A.ZeanahC. H. (2011). The effects of severe psychosocial deprivation and foster care intervention on cognitive development at 8 years of age: Findings from the Bucharest Early Intervention Project. Journal of Child Psychology and Psychiatry, 52(9), 919–928. https://doi.org/10.1111/j.1469-7610.2010.02355.x
25.
FoxN. A.CalkinsS. D. (2003). The development of self-control of emotion: Intrinsic and extrinsic influences. Motivation and Emotion, 27(1), 7–26. https://doi.org/10.1023/A:1023622324898
26.
GieddJ. N.BlumenthalJ.JeffriesN. O.CastellanosF. X.LiuH.ZijdenbosA.PausT.EvansA. C.RapoportJ. L. (1999). Brain development during childhood and adolescence: A longitudinal MRI study. Nature Neuroscience, 2(10), 861–863. https://doi.org/10.1038/13158
27.
GleasonM. M.FoxN. A.DruryS. S.SmykeA. T.NelsonC. A.IIIZeanahC. H. (2014). Indiscriminate behaviors in previously institutionalized young children. Pediatrics, 133(3), e657–e665. https://doi.org/10.1542/peds.2013-0212
28.
GreshamF. M.ElliottS. N. (1990). Social skills rating system (SSRS). American Guidance Service.
29.
GreshamF. M.ElliottS. N.VanceM. J.CookC. R. (2011). Comparability of the social skills rating system to the social skills improvement system: Content and psychometric comparisons across elementary and secondary age levels. School Psychology Quarterly, 26(1), 27–44. https://doi.org/10.1037/a0022662
30.
GunnarM. R.BruceJ.GrotevantH. D. (2000). International adoption of institutionally reared children: Research and policy. Development and Psychopathology, 12(4), 677–693. https://doi.org/10.1017/s0954579400004077
31.
GunnarM. R.van DulmenM. H. M., & International Adoption Project Team. (2007). Behavior problems in postinstitutionalized internationally adopted children. Development and Psychopathology, 19(1), 129–148. https://doi.org/10.1017/S0954579407070071
32.
Guyon-HarrisK. L.HumphreysK. L.FoxN. A.NelsonC. A.ZeanahC. H. (2018). Course of disinhibited social engagement disorder from early childhood to early adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 57(5), 329–335.e2. https://doi.org/10.1016/j.jaac.2018.02.009
33.
Guyon-HarrisK. L.HumphreysK. L.FoxN. A.NelsonC. A.ZeanahC. H. (2019). Signs of attachment disorders and social functioning among early adolescents with a history of institutional care. Child Abuse & Neglect, 88, 96–106. https://doi.org/10.1016/j.chiabu.2018.11.005
34.
HayesA. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.
HuL.BentlerP. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
37.
HumphreysK. L.Gabard-DurnamL.GoffB.TelzerE. H.FlanneryJ.GeeD. G.ParkV.LeeS. S.TottenhamN. (2019). Friendship and social functioning following early institutional rearing: The role of ADHD symptoms. Development and Psychopathology, 31(4), 1477–1487. https://doi.org/10.1017/s0954579418001050
38.
HumphreysK. L.GleasonM. M.DruryS. S.MironD.NelsonC. A.FoxN. A.ZeanahP. C. H. (2015). Effects of institutional rearing and foster care on psychopathology at age 12 years in Romania: Follow-up of an open, randomised controlled trial. LancetPsychiatry, 2(7), 625–634. https://doi.org/10.1016/S2215-0366(15)00095-4
39.
HumphreysK. L.MironD.McLaughlinK. A.SheridanM. A.NelsonC. A.FoxN. A.ZeanahC. H. (2018). Foster care promotes adaptive functioning in early adolescence among children who experienced severe, early deprivation. Journal of Child Psychology and Psychiatry and Allied Disciplines, 59(7), 811–821. https://doi.org/10.1111/jcpp.12865
40.
JulianM. M.McCallR. B. (2016). Social skills in children adopted from socially-emotionally depriving institutions. Adoption Quarterly, 19(1), 44–62. https://doi.org/10.1080/10926755.2015.1088106
41.
KimJ.CicchettiD. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 51(6), 706–716. https://doi.org/10.1111/j.1469-7610.2009.02202.x
42.
KleinD. N.DoughertyL. R.OlinoT. M. (2005). Toward guidelines for evidence-based assessment of depression in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), 412–432. https://doi.org/10.1207/s15374424jccp3403_3
43.
KramerT.PhillipsS. D.HargisM. B.MillerT. L.BurnsB. J.RobbinsJ. M. (2004). Disagreement between parent and adolescent reports of functional impairment. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45(2), 248–259. https://doi.org/10.1111/j.1469-7610.2004.00217.x
44.
LaceulleO. M.VeenstraR.VolleberghW. A. M.OrmelJ. (2019). Sequences of maladaptation: Preadolescent self-regulation, adolescent negative social interactions, and young adult psychopathology. Development and Psychopathology, 31(1), 279–292. https://doi.org/10.1017/S0954579417001808
45.
LubyJ. L.HeffelfingerA.MeaselleJ. R.AblowJ. C.EssexM. J.DierkerL.HarringtonR.KraemerH. C.KupferD. J. (2002). Differential performance of the MacArthur HBQ and DISC-IV in identifying DSM-IV internalizing psychopathology in young children. Journal of the American Academy of Child and Adolescent Psychiatry, 41(4), 458–466. https://doi.org/10.1097/00004583-200204000-00019
46.
MarshallP. J.ReebB. C.FoxN. A.NelsonC. A.ZeanahC. H. (2008). Effects of early intervention on EEG power and coherence in previously institutionalized children in Romania. Development and Psychopathology, 20(3), 861–880. https://doi.org/10.1017/S0954579408000412
47.
MartelM. M.PanP. M.HoffmannM. S.GadelhaA.do RosárioM. C.MariJ. J.ManfroG. G.MiguelE. C.PausT.BressanR. A.RohdeL. A.SalumG. A. (2017). A general psychopathology factor (P Factor) in children: Structural model analysis and external validation through familial risk and child global executive function. Journal of Abnormal Psychology, 126(1), 137–148. https://doi.org/10.1037/abn0000205
48.
MaszkP.EisenbergN.GuthrieI. K. (1999). Relations of children’s social status to their emotionality and regulation: A short-term longitudinal study. Merrill-Palmer Quarterly, 45(3), 468–492.
49.
McLaughlinK. A.FoxN. A.ZeanahC. H.NelsonC. A. (2011). Adverse rearing environments and neural development in children: The development of frontal electroencephalogram asymmetry. Biological Psychiatry, 70(11), 1008–1015. https://doi.org/https://doi.org/10.1016/j.biopsych.2011.08.006
50.
MillumJ.EmanuelE. J. (2007). Ethics. The ethics of international research with abandoned children. Science, 318(5858), 1874–1875. https://doi.org/10.1126/science.1153822
51.
MoffittT. E.ArseneaultL.BelskyD.DicksonN.HancoxR. J.HarringtonH.HoutsR.PoultonR.Roberts.B. W.RossS.SearsM. R.ThomsonW. M.CaspiA. (2011). A gradient of childhood self-control predicts health, wealth, and public safety. Proceedings of the National Academy of Sciences, USA, 108(7), 2693–2698. https://doi.org/10.1073/pnas.1010076108
52.
MuthénL. K.MuthénB. O. (2012). Mplus user’s guide (7th ed.). Los Angeles, CA: Author.
53.
NelsonC. A.ZeanahC. H.FoxN. A.MarshallP. J.SmykeA. T.GuthrieD. (2007). Cognitive recovery in socially deprived young children: The Bucharest Early Intervention Project. Science, 318(5858), 1937–1940. https://doi.org/10.1126/science.1143921
54.
Ng-KnightT.SheltonK. H.RiglinL.McManusI. C.FredericksonN.RiceF. (2016). A longitudinal study of self-control at the transition to secondary school: Considering the role of pubertal status and parenting. Journal of Adolescence, 50, 44–55. https://doi.org/10.1016/j.adolescence.2016.04.006
55.
PitulaC. E.ThomasK. M.ArmstrongJ. M.EssexM. J.CrickN. R.GunnarM. R. (2014). Peer victimization and internalizing symptoms among post-institutionalized, internationally adopted youth. Journal of Abnormal Child Psychology, 42(7), 1069–1076. https://doi.org/10.1007/s10802-014-9855-z
56.
PollakS. D.NelsonC. A.SchlaakM. F.RoeberB. J.WewerkaS. S.WiikK. L.FrennK. A.LomanM. M.GunnarM. R. (2010). Neurodevelopmental effects of early deprivation in postinstitutionalized children. Child Development, 81(1), 224–236. https://doi.org/10.1111/j.1467-8624.2009.01391.x
57.
RosarioM.SalzingerS.FeldmanR. S.Ng-MakD. S. (2008). Intervening processes between youths’ exposure to community violence and internalizing symptoms over time: The roles of social support and coping. American Journal of Community Psychology, 41(1–2), 43–62. https://doi.org/10.1007/s10464-007-9147-7
58.
SameroffA. J.MackenzieM. J. (2003). Research strategies for capturing transactional models of development: The limits of the possible. Development and Psychopathology, 15(3), 613–640. https://doi.org/10.1017/S0954579403000312
59.
ShirtcliffE. A.EssexM. J. (2008). Concurrent and longitudinal associations of basal and diurnal cortisol with mental health symptoms in early adolescence. Developmental Psychobiology, 50(7), 690–703. https://doi.org/10.1002/dev.20336
60.
SkuseD. H.MandyW.SteerC.MillerL. L.GoodmanR.LawrenceK.EmondA.GoldingJ. (2009). Social communication competence and functional adaptation in a general population of children: Preliminary evidence for sex-by-verbal IQ differential risk. Journal of the American Academy of Child and Adolescent Psychiatry, 48(2), 128–137. https://doi.org/10.1097/CHI.0b013e31819176b8
61.
SmykeA. T.KogaS. F.JohnsonD. E.FoxN. A.MarshallP. J.NelsonC. A.ZeanahC. H. (2007). The caregiving context in institution-reared and family-reared infants and toddlers in Romania. Journal of Child Psychology and Psychiatry, 48(2), 210–218. https://doi.org/10.1111/j.1469-7610.2006.01694.x
62.
SmykeA. T.ZeanahC. H.FoxN. A.NelsonC. A. (2009). A new model of foster care for young children: The Bucharest Early Intervention Project. Child and Adolescent Psychiatric Clinics of North America, 18(3), 721–734. https://doi.org/10.1016/j.chc.2009.03.003
63.
SomervilleL. H.JonesR. M.CaseyB. J. (2010). A time of change: Behavioral and neural correlates of adolescent sensitivity to appetitive and aversive environmental cues. Brain and Cognition, 72(1), 124–133. https://doi.org/10.1016/j.bandc.2009.07.003
64.
Sonuga-BarkeE. J. S.KennedyM.KumstaR.KnightsN.GolmD.RutterM.MaughanB.SchlotzW.KreppnerJ. (2017). Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: The young adult follow-up of the longitudinal English and Romanian Adoptees study. The Lancet, 389(10078), 1539–1548. https://doi.org/10.1016/S0140-6736(17)30045-4
65.
TottenhamN.HareT. A.QuinnB. T.McCarryT. W.NurseM.GilhoolyT.MillnerA.GalvanA.DavidsonM. C.EigstiI. M.ThomasK. M.FreedP. J.BoomaE. S.GunnarM. R.AltemusM.AronsonJ.CaseyB. J. (2010). Prolonged institutional rearing is associated with atypically large amygdala volume and difficulties in emotion regulation. Developmental Science, 13(1), 46–61. https://doi.org/10.1111/j.1467-7687.2009.00852.x
66.
TrentacostaC. J.ShawD. S. (2009). Emotional self-regulation, peer rejection, and antisocial behavior: Developmental associations from early childhood to early adolescence. Journal of Applied Developmental Psychology, 30(3), 356–365. https://doi.org/10.1016/j.appdev.2008.12.016
67.
Van der EndeJ.VerhulstF. C.TiemeierH. (2012). Agreement of informants on emotional and behavioral problems from childhood to adulthood. Psychological Assessment, 24(2), 293–300. https://doi.org/10.1037/a0025500
68.
VanderwertR. E.MarshallP. J.NelsonC. A.ZeanahC. H.FoxN. A. (2010). Timing of intervention affects brain electrical activity in children exposed to severe psychosocial neglect. PLOS ONE, 5(7), Article e11415. https://doi.org/10.1371/journal.pone.0011415
69.
VazsonyiA. T.HuangL. (2010). Where self-control comes from: On the development of self-control and its relationship to deviance over time. Developmental Psychology, 46(1), 245–257. https://doi.org/10.1037/a0016538
70.
WadeM.FoxN. A.ZeanahC. H.NelsonC. A. (2018). Effect of foster care intervention on trajectories of general and specific psychopathology among children with histories of institutional rearing: A randomized clinical trial. JAMA Psychiatry, 75(11), 1137–1145. https://doi.org/10.1001/jamapsychiatry.2018.2556
71.
WadeM.FoxN. A.ZeanahC. H.NelsonC. A. (2019). Long-term effects of institutional rearing, foster care, and brain activity on memory and executive functioning. Proceedings of the National Academy of Sciences, USA, 116(5), 1808–1813. https://doi.org/10.1073/pnas.1809145116
72.
WadeM.ZeanahC. H.FoxN. A.NelsonC. A. (2020). Global deficits in executive functioning are transdiagnostic mediators between severe childhood neglect and psychopathology in adolescence. Psychological Medicine, 50(10), 1687–16941. https://doi.org/10.1017/S0033291719001764
73.
WechslerD. (2003). Wechsler Intelligence Scale for Children (4th ed.). Psychological Corporation.
74.
WiikK. L.LomanM. M.Van RyzinM. J.ArmstrongJ. M.EssexM. J.PollakS. D.GunnarM. R. (2011). Behavioral and emotional symptoms of post-institutionalized children in middle childhood. Journal of Child Psychology and Psychiatry, 52(1), 56–63. https://doi.org/10.1111/j.1469-7610.2010.02294.x
75.
YuleK.HoustonJ.GrychJ. (2019). Resilience in children exposed to violence: A meta-analysis of protective factors across ecological contexts. Clinical Child and Family Psychology Review, 22, 406–431. https://doi.org/10.1007/s10567-019-00293-1
76.
ZeanahC. H.FoxN. A.NelsonC. A. (2012). The Bucharest Early Intervention Project: Case study in the ethics of mental health research. Journal of Nervous and Mental Disease, 200(3), 243–247. https://doi.org/10.1097/NMD.0b013e318247d275
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