Effects of family risk on early attachment security: Gender-specific susceptibility and mediation by parenting behavior

Growing up in high-risk environments is detrimental to children’s development of attachment security. Parenting behavior is hypothesized to be the mechanism through which risks exert their influence. However, risk influences can vary between individuals by gender. Aim of this study was to explore specific pathways of family risk on early attachment security and additionally examine the transmission via parenting behavior. The sample consisted of 197 children and their primary caregivers. Children’s age ranged between 10 and 21 months ( M = 15.25, SD = 3.59). Data assessment included 21 distal and proximal family risk factors, children’s attachment security, and parental responsivity and supportive presence. Whereas distal risk factors had an adverse effect only on girls’ attachment security, proximal risks negatively affected only boys’ attachment security. Additionally, patterns of risk factors occurring in our sample were analyzed using an exploratory principal component analysis. Regardless of the child’s gender, a low socio- economic status was negatively related to attachment security of all children. Migration and crowding and a high emotional load of the primary caregiver both negatively predicted girls’ but not boys’ attachment security. However, the attachment security of boys was affected by a negative family climate. Most of the adverse risk effects on attachment security were mediated by parental responsivity and supportive presence so that the transmission of risk occurs through parenting behavior. Results revealed a different susceptibility of family risks for girls and boys. The consideration of a gender-sensitive approach in developmental psychopathology and interventions of developmental child welfare services is recommended.

A quick and reliable waiting room checklist for symptoms of disinhibited social engagement disorder

Background: Disinhibited social engagement disorder (DSED) is a psychosocial disorder, associated with child neglect, characterised by indiscriminate friendliness towards strangers. Some behavioural overlap between DSED and autism spectrum disorder (ASD) – a neurodevelopmental condition whose core symptoms include impaired communication – has been observed. Since DSED is associated with a maltreatment history and ASD is not, differential diagnosis is important. We aimed to establish norms and reference ranges for a clinic waiting room checklist (WRO) for the observation of DSED symptoms, and to examine its discrimination between DSED and ASD. Methods: Norms are provided for the WRO based on 56 children aged 5–12 with DSED and 151 typically developing controls, for whom a reference range is also provided. We modified the WRO based on both quantitative examination of discrimination between DSED and ASD ( n = 16) and qualitative observations of typically developing children ( n = 7), children with DSED ( n = 5) and ASD ( n = 6). Results: A WRO score >6 may indicate the need for a multi-informant assessment for DSED. In a waiting room, children from both atypical groups (ASD and DSED) were more likely to approach strangers than controls; however, while children with DSED symptoms appeared to take control of the social aspects of the situation, children with ASD followed a non-social agenda, with the stranger appearing irrelevant. Conclusion: The WRO is an efficient tool that, along with information from parents and teacher, can contribute to clinical decision-making regarding children who have difficulties with social relationships.

Reasons why Prescribers Decrease Psychotropic Medication for Foster Youth

Although prescribers frequently use psychotropic medication to treat emotional and behavioral problems for children in foster care, and states are required to monitor psychotropic medication usage with foster youth, few studies have evaluated the extent to which prescribers decrease psychotropic medication. We developed a system to track medication decreases for foster youth to ascertain why deprescriptions occurred. Researchers reviewed case files for 223 children and adolescents in a child welfare system who had received services via a state-funded project from October 2016 through January 2021. We found 99 individuals who had (a) prescriptions for one or more psychotropic medications at intake and (b) received both behavioral and medication review services. Results show only 32 (32%) of individuals in this sample experienced a deprescription of psychotropic medication while receiving services from the project. Analyses for these 32 individuals revealed four key findings. First, the most frequently deprescribed medications were stimulants and antipsychotics. Second, the most common reasons for decreasing any psychotropic medication were (a) medication advocacy and (b) adverse side effects. Notably, only foster youth aged 12 years or younger experienced medication reductions due to adverse side effects. Third, stimulants and antipsychotics accounted for the highest percentage of undesirable side effects. Fourth, practitioners deprescribed stimulants and antipsychotics for adverse side effects two times more often than for behavior or symptom improvement. These findings may contribute to the development of deprescribing guidelines for children in state welfare systems.

Youth, prosociality, and child welfare: an investigation of positive peer influence and youth prosocial behavior in group home care

Only a limited number of studies have investigated the association between positive peer influence and youth prosocial behavior in child welfare. None of such studies has been completed in group home setting for youth. This study aimed to examine if positive peer influence is associated with (or predicts) youth prosocial behavior. The Ontario Looking After Children (OnLAC) database was used for analysis. There were 875 participants (males and females) aged 10 to 17 who were surveyed in group homes in 2010–2011. A full regression analysis found strong association between positive peer influence and youth prosocial behavior. The main predictive effect of gender was observed to be modestly associated with youths’ prosocial behavior as demonstrated by the adjusted and unadjusted main predictive effects (OR = .67 and .63). There was a significant positive peer influence by group home size interaction and its moderating effect was such that positive peer influence significantly predicted youths’ prosocial behaviors in small homes (incremental ORs of 2.00 and 4.49), but not in large homes. Findings show that positive peer influence informs youth prosocial behaviors in group homes.

Asylum-seeking children in shutdown: Neurobiological models

Asylum-seeking children presenting in the shutdown state have been the subject of much discussion and controversy—on both government and medical system levels—in Australia and in Sweden. In this article, we conceptualize the shutdown state as an evolutionary response to extreme threat. We adopt a neuroscience approach to present five plausible models for explaining this shutdown state, their strengths and shortcomings, and the overlaps between them. Model 1—the sustained autonomic arousal model—draws on polyvagal theory. Model 2—the innate-defence model—draws on research pertaining to animal and human innate defence responses. Model 3—the catatonia model—draws on clinical and research data with patients presenting with catatonia. Model 4—the hypometabolic model—draws on an emerging body of work pertaining to hypometabolic states in animals and humans. Model 5—the defence cascade model of dissociation—draws on clinical research pertaining to human trauma states that present as dissociation. At present, each of the models provides a plausible pathophysiological explanation—or a component of a potential pathophysiological explanation—and none of them, for the moment, has enough evidence to be either accepted or disregarded. We hope that our discussion of the models advances scientific discussion and opens up possibilities for effective treatment.

Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Children at risk for placement instability are subpopulation in out-of-home care with a critical need for enhanced mental health services, but little is known about the types and adequacy of the mental services they receive. This descriptive study sought to identify the types of mental health services and psychotropic medications provided to children with a risk for moves, foster parents’ perceptions of their adequacy, consistency of therapy services with evidence-based models, and racial and gender differences in service provision. Foster parents completed telephone surveys for a randomly selected sample of 144 children aged 8–14 in specialized or traditional family foster care with a history of placement moves or hospitalizations in a large state in the US. Over two-thirds of children were reported to have mental health diagnoses, with ADHD most frequent (52%). Most children with a diagnosis received psychotherapy (75%) and psychotropic medications (90%). The majority did not receive additional services. A quarter received therapy supporting use of behavioral interventions in foster homes, with 40% of foster parents reporting this was inadequate. Additionally, half reported inadequate initial training. No racial differences in services were reported. However, girls were more likely to receive therapy described as trauma-focused than boys (30.9% and 5.6%, respectively); more boys received treatment for anger (17%) and psychotropic medication (60%). Findings indicate that children at risk for multiple moves receive a high level of services, but questions are raised about the content and adequacy of these services. Evidence-based psychosocial interventions are needed to support positive outcomes and potentially reduce psychotropic medication use.

The impact of COVID-19 on child welfare-involved families: Implications for parent–child reunification and child welfare professionals

The COVID-19 pandemic has impacted children and parents involved in the child welfare system and the professionals working with these families. Using survey data collected August–September of 2020, this mixed-methods study examined the perspectives of 196 child welfare-involved professionals (77 attorneys, 99 caseworkers, and 20 therapists) in the United States about the impact of COVID-19 on parents of origin, children, foster parents, and child welfare professionals. Particular attention was paid to the implications of COVID-19 and associated challenges for parent–child contact and reunification. With respect to professional stresses, more than half of participants worried about their own personal safety and health amidst COVID-19, and more than three-quarters expressed concerns about the safety and well-being of child welfare-involved families. Participants, especially attorneys, expressed concerns about parent–child contact and disruptions to reunification. In-person parent–child visits had all but ceased during the early part of the pandemic, and participants identified barriers to effective virtual visits, including lack of foster parent oversight, technology issues, and children’s developmental stage and/or lack of engagement. Attorneys were especially critical of the cessation of in-person visits and viewed this as a serious threat to child-parent bonds and reunification. Participants, especially child welfare workers, voiced concerns about children’s mental health and educational outcomes amidst the pandemic. Findings have implications for attorneys, child welfare workers, and other practitioners who directly and indirectly interface with child welfare-involved families.

During and beyond the frequent lockdowns: Addressing the pandemic (COVID-19)–related family violence through informal social control

Growing literature on COVID-19 shows an increase in family violence and child maltreatment cases as a result of the public health preventive measures including lockdowns and movement restrictions. These restrictions negatively affect victims’ ability to seek social services or leave the violent relationship. There are some indications of hope, however, as countries have begun easing restrictions which may enable victims to seek social services. Yet, the fluidity of COVID-19, emergence of complex variants of COVID-19 virus, continues restrictions on face-to-face engagements and evidence of re-entry into lockdown suggest that social services would not be fully available for victims of family violence. We offer a practical community intervention approach through informal social control for victims of family violence during and even after the COVID-19 pandemic.

Impact of COVID-19 on resource families: Unique challenges and strengths

The emergence of COVID-19 forced significant adaptations for families worldwide. Children and youth in foster care and their caregivers or resource parents experience unique stressors. The current study aimed to understand the impact of the COVID-19 pandemic and “Safer-at-Home” orders on resource parents in Los Angeles County. Resource parents (n = 648) were surveyed about COVID-19 concerns, positive impact and strengths, access to and helpfulness of provided resources, visits with birth parents, children joining their families during the pandemic, and transition to telehealth. Between one-third and half of resource parents with foster or foster-adoptive children in their home reported significant anxiety about issues such as getting infected, uncertainty about the future, and financial hardship. In contrast, most resource parents reported some perceived benefits, such as increased family closeness. The most helpful resource reported was video visitation by social workers. A quarter of resource parents experienced in-person birth parent visits. Developmentally, parents with a foster or fosteradoptive child 0–5 years old reported significantly more worries related to COVID-19, while those with children of multiple ages reported feeling less valued as a resource parent and expressed more concerns about children falling behind with school, mental health and developmental services, birth parent visits, and delayed reunification. Lastly, younger parental age, fewer foster children in the home, and the less negative impact from COVID-19 a resource parent reported having were associated with an increased likelihood of resource parents welcoming a child into their home. Implications for policy and recommendations for practice are discussed.

The impact of care-related factors on the language and communication needs of looked after and adopted children/young people

It is established that the development of psychological well-being and cognitive skills for Looked After and Adopted Children/Young People (LAACYP) is impacted by their experiences before and after entry into care. Language and communication skills are typically considered to have a reciprocal relationship with cognitive development, but the language skills of the LAACYP population are currently underspecified. The current study explores the severity and specificity of language and communication difficulty in a LAACYP population and the association between these difficulties and several care-related factors, including mental health and Adverse Childhood Experiences (ACEs). Fifty-seven children aged 4–16 either in foster care or an adoptive placement were sampled via carer-report, using the Children’s Communication Checklist 2. Forty-two of these children’s mental health needs were also sampled using the Assessment Checklist for Children. The child’s social worker completed information regarding ACEs and care-related factors. Based on UK norms, the performance of 68% of the children sampled was consistent with the lowest 10% of the general population for language and communication ability. Similar levels of severity were found for both structural and pragmatic abilities. Language and communication difficulties were associated with older children, later age of entry into care and placement type (foster care vs. adoption) but not placement disruption. A significant relationship was found between mental health and language difficulty, but no link was established with ACEs. This study highlights the severity and pervasiveness of language and communication impairment among many of the LAACYP population and its association with psychological well-being.