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PubMed2006

Young children in institutional care at risk of harm.

A recent survey has revealed a large number of young children in institutional care across Europe. Young children placed in institutional care without parents may be at risk of harm. This review considers systematically the research evidence on the impact of institutional care on brain growth, attachment, social behavior, and cognitive development. Analytical epidemiological study designs (i.e., including a control/comparison group) show that young children placed in institutional care are at risk of harm in terms of attachment disorder and developmental delays in social, behavioral, and cognitive domains. Delays in physical growth, neural atrophy, and abnormal brain development have also been implicated. The findings suggest that the lack of a one-to-one relationship with a primary caregiver is a major cause of harm to children in residential care. Evidence indicates that infants who are placed in institutional care will suffer harm to their development if they are not moved to family-based care by the age of 6 months. The neglect and damage caused by early privation and deprivation is equivalent to violence and policy makers should work to ensure that every child has the opportunity to grow up in a family environment.

Adaptation, Psychological↗
PubMed1979

Psychiatric disorders in children in long-term residential care: a follow-up study.

Ninety-two children who had been examined in a psychiatric study of five to twelve year-olds in long-term residential care were followed up four years later. Three-quarters were still in children's homes, but over half had been moved to different establishments. At both the original study and follow-up, the majority showed evidence of psychiatric disorder. Considerable continuity of behavioural pattern was found, particularly amongst those who originally had antisocial disorders, who were also most likely to have had changes of care-taker during the four years. It is suggested that the persistence of their disorder may be due to a vicious circle of unacceptable behaviour and adult rejection.

Child↗
PubMed2001

Specificity and heterogeneity in children's responses to profound institutional privation.

BACKGROUND: The sequelae of profound early privation are varied. AIMS: To delineate the behavioural patterns that are specifically associated with institutional privation. METHOD: A group of 165 children adopted from Romania before the age of 42 months were compared at 4 years and 6 years with 52 non-deprived UK children adopted in infancy. Dysfunction was assessed for seven domains of functioning. The groups were compared on which, and how many, domains were impaired. RESULTS: Attachment problems, inattention/overactivity, quasi-autistic features and cognitive impairment were associated with institutional privation, but emotional difficulties, poor peer relationships and conduct problems were not. Nevertheless, one-fifth of children who spent the longest time in institutions showed normal functioning. CONCLUSIONS: Attachment disorder behaviours, inattention/overactivity and quasi-autistic behaviour constitute institutional privation patterns.

Adoption↗
PubMed1982

The integration of the Foster Grandparent Program with an acute Care Psychiatric Service.

In an effort to provide special relationships and attention for the children and adolescents hospitalized on the acute care psychiatry wards, one hospital established a unit of foster grandparents. The article describes the problems encountered in the development of similar programs, particularly in multidiscipline settings. The article also describes how the foster grandparents became active members on the service's multidiscipline teams, participating in the assessment of patients and contributing to their treatment.

Adolescent↗
PubMed2003

Allergen-specific immunoglobulin E antibodies in wheezing infants: the risk for asthma in later childhood.

OBJECTIVE: To evaluate whether the measurement of specific immunoglobulin E (IgE) antibodies to food and/or inhalant allergens in infants who are hospitalized for wheezing can be used to predict later asthma. METHODS: Eighty-two children who were hospitalized for wheezing at <2 years of age were followed prospectively until early school age. The baseline data and the characteristics of infancy had been collected at enrollment. At school age, the children were evaluated for asthma and allergic manifestations, including skin prick tests to common inhalant allergens. Frozen serum samples obtained during the index episode of wheezing were available for 80 children for determination of food and inhalant allergen-specific serum IgE antibodies by fluoroenzyme-immunometric assay, UniCAP, applying the Phadiatop Combi allergen panel. RESULTS: Asthma was present in 32 (40%) children at school age. Food-specific IgE antibodies of >or=0.35 kU/L were found in 37 (46%) wheezing infants, but only specific IgE to wheat and to egg white at the level of >or=0.35 kU/L were significantly associated with later asthma. In regard to specific IgE to the mixture of food allergens, the cutoff level of >or=0.70 proved to be significant. Inhalant allergen-specific IgE of >or=0.35 kU/L was found only in 14 cases (18%), but when present, it was significantly predictive of asthma. Elevated levels of specific IgE antibodies to food or inhalant allergens were significantly associated with allergic rhinitis and skin-test reactivity at school age. CONCLUSIONS: When present in wheezing infants, specific IgE of >or=0.35 kU/L to wheat, egg white, or inhalant allergens are predictive of later childhood asthma. Consequently, detection of those specific IgE antibodies in wheezing infants may facilitate the early diagnosis of asthma, especially in cases with no clinically evident atopic manifestations.

Allergens↗
PubMed2005

Health of children adopted from Guatemala: comparison of orphanage and foster care.

OBJECTIVE: Since 1986, American parents have adopted >17300 children from Guatemala. This study assessed the health, growth, and developmental status of 103 Guatemalan adopted children (48 girls; 55 boys) after arrival in the United States. Physical evidence suggestive of prenatal alcohol exposure and adequacy of vaccinations administered were also reviewed. METHODS: Retrospective chart review was conducted of 103 children who were evaluated after arrival in the United States in an international adoption specialty clinic, and a case-matched study was conducted of a subgroup of 50 children who resided in either an orphanage or foster care before adoption. Mean age at arrival was 16 +/- 19 months. Before adoption, 25 children resided in orphanages, 56 resided in foster care, and 22 resided in mixed-care settings. The 25 children who had resided in orphanages before adoption were matched for age at arrival, interval from arrival to clinic visit, and gender with a child adopted from foster care. Health and developmental status of these matched pairs were compared, allowing the first direct comparison of children raised in orphanages or foster care before adoption. RESULTS: Mild growth delays were frequent among the children. Mean z scores for weight, height, and head circumference were, respectively, -1.00, -1.04, and -1.08. Children from foster care had significantly better z scores for height, weight, and head circumference than those from orphanage or mixed care. Among children who were younger than 2 years at arrival, growth measurements correlated inversely with age at arrival. Infectious diseases included intestinal parasites (8%) and latent tuberculosis infection (7%). Other medical conditions included anemia (30%), elevated lead levels (3%), and (using strict criteria) phenotypic facial features suggestive of prenatal alcohol exposure (28%). Adequacy of vaccine records from Guatemala was assessed: 28% met American Academy of Pediatrics standards for vaccine administration. Unsuspected significant medical diagnoses, including congenital anomalies and ocular, neurologic, and orthopedic problems, were found in 14%. Most children were doing well developmentally (80-92% of expected performance), but 14% had global developmental delays. Cognition, expressive and receptive language, and activities of daily living skills correlated inversely with age at arrival for children who were younger than 2 years at adoption. Among the 50 matched children, those who resided in foster care before adoption had better measurements for height, weight, and head circumference at arrival to the United States. Moreover, those who resided in foster care scored significantly better for cognitive skills than those who had previously resided in orphanages (96.3% of age-expected compared with 88.3% of age-expected); other skills did not differ between the 2 groups. No differences were found between the 2 groups of children related to prevalence of medical diagnoses or phenotypic evidence suggesting prenatal alcohol exposure. CONCLUSIONS: Guatemalan adoptees display similar overall patterns of growth and developmental delays as seen in other groups of internationally adopted children, although not as severe. Younger children had better growth and development (cognition, language, and activities of daily living skills) than older children, regardless of location of residence before adoption. Among children who were matched for age, gender, and interval from adoption to evaluation, those who had resided in foster care had better growth and cognitive scores than children who had resided in orphanages before adoption. These findings support the need for timely adoptive placement of young infants and support the placement of children in attentive foster care rather than orphanages when feasible.

Adoption↗
PubMed1990

Assessing and improving child care: a personal appearance index for children with autism.

An index of children's physical appearance and personal care was developed and used to assess youngsters with autism who lived (a) at home, (b) in an established group home, (c) in new group homes, and (d) in a large institution. Subsequently, a multiple baseline design across participants documented major changes in personal appearance and cleanliness when children moved from an institution to community-based, family-style group homes. Finally, data-based feedback generated by the appearance index was used as a training tool enabling group home staff to further improve child appearance. This research demonstrates how an evaluation instrument can be used to obtain comparative data, measure some effects of different residential placements, and provide ongoing feedback to caregivers to promote high standards of personal care among persons with severe developmental disabilities.

Activities of Daily Living↗
PubMed1997

Functional analysis and treatment of elopement.

Elopement is a dangerous behavior because children who run away may encounter life-threatening situations (e.g., traffic). We conducted functional analyses of the elopement of 3 children who had been diagnosed with developmental disabilities. The results identified a maintaining reinforcer for the elopement of 1 child, but the data were difficult to interpret for 2 of the children. Subsequent reinforcer assessments were used to help to clarify the reinforcers for elopement for these 2 children. Results of the functional analyses and reinforcer assessments then were used to develop successful treatments to reduce elopement. The findings are discussed in terms of (a) the application of functional analysis methodology to elopement, (b) the use of reinforcer assessments to identify potential reinforcers when standard functional analyses are undifferentiated, and (c) the utility of assessment-based treatments for elopement.

Behavior Therapy↗
PubMed1991

[Prevalence of Enterobius vermicularis infection and preventive effects of mass treatment among children in rural and urban areas, and children in orphanages].

An epidemiological study and mass treatments of Enterobius vermicularis infection among children near Wonju area of Kangwon province were carried out. The children were divided into 4 groups according to their residing localities; children in the mountainous area, rural area, urban area and in orphanage. They were examined by adhesive cellotape anal swab technique, and egg positive rates were obtained. The rates of egg reduction and re-infection rates after repeated mass treatments were also observed. The results obtained were as follows: 1. The overall egg positive rate of E. vermicularis in the first screening was 19.9% (251 out of 1,262 examinees; 19.7% in males and 20.1% in females). The positive rates were 13.0% in the mountainous area, 11.9% in the rural area, 15.1% in the urban (medium-sized) area and 61.9% in orphanages. 2. The highest positive rates were observed in the kindergarten children, and 1st and 2nd grade children of primary schools (26.2-32.2%), and the lowest rate (13.6%) in 6-year grade children of primary schools. 3. Cumulative detection rates from 3 repeated anal swabs at 4-5 days interval were higher (70.8%) than those from single anal swabs (50.0-59.2%). 4. Out of the examinees who showed the highest cumulative positive rate (70.8%), about 39.2% were consecutively positive in 3 anal swabs. Among different groups of children, the higher the total egg detection rates (87.5%), the higher the consecutive positive rates (71.9%). 5. A total of 2,609 (male: female = 1:12.4) worms were collected from 17 egg-positive cases treated with anthelmintics. The mean number of worms per child was 153 (range: 4-824).(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗