CAREGIVER SENSITIVITY AND CONSISTENCY AND CHILDREN'S PRIOR FAMILY EXPERIENCE AS CONTEXTS FOR EARLY DEVELOPMENT WITHIN INSTITUTIONS.

The current study addressed whether two institution-wide interventions in St. Petersburg, Russian Federation, that increased caregiver sensitivity (Training Only: TO) or both caregiver sensitivity and consistency (Training plus Structural Changes: T+SC) promoted better socioemotional and cognitive development than did a No Intervention (NoI) institution during the first year of life for children who were placed soon after birth. It also assessed whether having spent less than 9 versus 9 to 36 months with a family prior to institutionalization was related to children's subsequent socioemotional and cognitive development within these three institutions. The Battelle Developmental Inventory (J. Newborg, J.R. Stock, L. Wnek, J. Guidubaldi, & J. Svinicki, 1988) was used to assess the socioemotional and cognitive functioning of children in NoI (n = 95), TO (n = 104), and T+SC (n = 86) at two to three time points during their first 6 to 12 months of residency. Results suggest that improving caregiver sensitivity can improve the cognitive development of infants in the first year of institutionalization whereas improving caregiver consistency in addition to sensitivity is more beneficial for socioemotional development than is sensitivity alone. Similarly, for children in T+SC, longer time with a family prior to institutionalization (consistent caregiver, unknown sensitivity) was associated with better socioemotional, but not cognitive, baseline scores and more rapid cognitive than socioemotional development during institutionalization. These results suggest caregiver sensitivity is more highly related to cognitive development whereas caregiver consistency is more related to socioemotional development in the first years of life.

CAREGIVER-CHILD INTERACTION, CAREGIVER TRANSITIONS, AND GROUP SIZE AS MEDIATORS BETWEEN INTERVENTION CONDITION AND ATTACHMENT AND PHYSICAL GROWTH OUTCOMES IN INSTITUTIONALIZED CHILDREN.

This report describes a secondary analysis of data from a comprehensive intervention project which included training and structural changes in three Baby Homes in St. Petersburg, Russian Federation. Multiple mediator models were tested according to the R.M. Baron and D.A. Kenny () causal-steps approach to examine whether caregiver-child interaction quality, number of caregiver transitions, and group size mediated the effects of the intervention on children's attachment behaviors and physical growth. The study utilized a subsample of 163 children from the original Russian Baby Home project, who were between 11 and 19 months at the time of assessment. Results from comparisons of the training and structural changes versus no intervention conditions are presented. Caregiver-child interaction quality and number of caregiver transitions fully mediated the association between intervention condition and attachment behavior. No other mediation was found. Results suggest that the quality of interaction between caregivers and children in institutional care is of primary importance to children's development, but relationship context may play a less direct mediational role, supporting caregiver-child interactions.

The development of postinstitutionalized versus parent-reared Russian children as a function of age at placement and family type.

A total of 149 children, who spent an average of 13.8 months in Russian institutions, were transferred to Russian families of relatives and nonrelatives at an average age of 24.7 months. After residing in these families for at least 1 year (average = 43.2 months), parents reported on their attachment, indiscriminately friendly behavior, social-emotional competencies, problem behaviors, and effortful control when they were 1.5-10.7 years of age. They were compared to a sample of 83 Russian parents of noninstitutionalized children, whom they had reared from birth. Generally, institutionalized children were rated similarly to parent-reared children on most measures, consistent with substantial catch-up growth typically displayed by children after transitioning to families. However, institutionalized children were rated more poorly than parent-reared children on certain competencies in early childhood and some attentional skills. There were relatively few systematic differences associated with age at family placement or whether the families were relatives or nonrelatives. Russian parent-reared children were rated as having more problem behaviors than the US standardization sample, which raises cautions about using standards cross-culturally.

IL-31-induced pruritus in dogs: a novel experimental model to evaluate anti-pruritic effects of canine therapeutics.

BACKGROUND: Pruritus is a characteristic clinical sign of allergic skin conditions including atopic dermatitis (AD) in the dog. IL-31 is a cytokine found in the serum of some dogs with AD and can induce pruritic behaviours in laboratory beagle dogs. HYPOTHESIS/OBJECTIVES: The objectives were to characterize an IL-31-induced pruritus model by evaluating the efficacy of prednisolone, dexamethasone and oclacitinib, and to compare the speed of anti-pruritic effects of oclacitinib against those of prednisolone and dexamethasone. ANIMALS: Purpose-bred beagle dogs were used in all studies. METHODS: Randomized, blinded, placebo-controlled studies were designed to evaluate and compare the anti-pruritic properties of prednisolone, dexamethasone and oclacitinib following a single intravenous injection of recombinant canine IL-31. Video surveillance was used to monitor and score pruritic behaviours in study animals. RESULTS: Prednisolone [0.5 mg/kg, per os (p.o.)] reduced IL-31-induced pruritus when given 10 h prior to observation. When the time interval between drug treatment and observation was shortened to 1 h, dexamethasone (0.2 mg/kg, intramuscular) but not prednisolone (0.25 or 0.5 mg/kg, p.o.) reduced IL-31-induced pruritus. Oclacitinib (0.4 mg/kg, p.o.) reduced pruritus when given 1, 6, 11 and 16 h prior to the observation period, and the anti-pruritic activity of oclacitinib was greater when compared to prednisolone and dexamethasone at all time points assessed. CONCLUSION AND CLINICAL IMPORTANCE: The efficacy of prednisolone, dexamethasone and oclacitinib in the IL-31-induced pruritus model gives confidence that this may be a relevant model for acute pruritus associated with allergic dermatitis including AD and can be used to evaluate novel compounds or formulations.

Social Skills in Children Adopted from Socially-Emotionally Depriving Institutions.

This study assessed social skills in post-institutionalized (PI) children with respect to age-at-adoption, age-at-assessment, and gender. Parent ratings of social skills (Social Skills Rating System) and behavior problems (Child Behavior Checklist) were obtained for 214 children and 127 adolescents who were adopted from socially-emotionally depriving Russian institutions. Results showed that children adopted before 18 months of age have better social skills than those adopted after this age; those assessed in childhood demonstrate better social skills than those assessed in adolescence. PI females, especially later-adopted adolescents, have particularly poor social skills. Children with poor social skills tend to have higher rates of behavior problems.

Global research, practice, and policy issues on the care of infants and young children at risk: the articles in context.

This Special Issue includes articles that contribute to (a) the global research base pertaining to the development of infants and toddlers at risk, primarily those who are institutionalized in lower resource countries; (b) interventions in institutions and to promote family alternatives to institutionalization; and (c) attempts to create modern child welfare systems emphasizing family care in entire states and countries. This introduction places these articles into the broader contexts of the literature in these three domains of interest. Across the world, urbanization, migration, armed conflict, epidemics, and famine disrupt families. Add poverty, abuse, neglect, and parental incapacity due to substance abuse and mental health problems, and the result is millions of children without parental care who come under governmental responsibility, often to be reared in institutions, and at risk for long-term developmental deficiencies and problems. Over the last 2 decades and especially recently, national and international governments and nongovernment organizations have increased efforts to help such children, especially those in low-resource countries. Two types of efforts have been made: one to improve the quality of care provided by institutions and the other to minimize the use of institutions and promote family residential care alternatives. The latter effort includes preventing family separations in the first place, reunification of children with birth families, and developing systems of kinship care, foster care, and adoption. This Special Issue of IMHJ is devoted to reports pertaining to issues in the research knowledge base, program practices, and countrywide policies for infants and young children at risk. We attempt in this introduction to place these reports in the broader context of this field, identify their unique contributions, and highlight lessons learned that can contribute to improved care practices and better child welfare systems.

Behavior problems in children transferred from a socioemotionally depriving institution to St. Petersburg (Russian Federation) families.

Behavior problems were studied in fifty 5- to 8-year-old children transferred from a socioemotionally depriving Russian institution to domestic families. Results indicated that the postinstitutional (PI) sample as a whole had higher clinical/borderline behavior problem rates on the parent-reported Child Behavior Checklist for Ages 6-18 (T.M. Achenbach & L.A. Rescorla, 2001) aggressive and lower rates on the withdrawn/depressed and internalizing problems scales than did non-institutionalized (non-I) children reared in Russian families. Compared with the U.S. standardization sample, PI children had significantly higher rates for aggressive, externalizing, and social problems; the non-I children had higher rates for withdrawn/depressed and internalizing problems; and both groups had higher rates for rule-breaking behavioral problems. PI children placed in domestic families at 18 months or older had higher rates of problems than did the U.S. non-I standardization sample, but children placed at younger ages did not. PI children transferred to nonbiological families had lower rates of problems compared to U.S. norms than did children transferred to biological families. Thus, prolonged early socioemotional deprivation was associated with a higher percentage of behavior problems in children placed in domestic families, especially if transferred to biological families.

Maintaining a social-emotional intervention and its benefits for institutionalized children.

This article reports the maintenance of one of the largest interventions conducted in St. Petersburg (Russian Federation) orphanages for children birth to 4 years using regular caregiving staff. One orphanage received training plus structural changes, another training only, and a third business as usual. The intervention produced substantial differences between these institutions on the Home Observation for Measurement of the Environment (HOME) Inventory and on the Battelle Developmental Inventory scores for children. These institutional differences in HOME scores (N = 298) and Battelle scores for children (N = 357) departing the institutions for families in St. Petersburg and the United States were maintained for at least 6 years after the intervention project. This result may be associated with certain features of the intervention and activities conducted during the follow-up interval.

Parent-reported executive functioning in postinstitutionalized children: a follow-up study.

This study compared parent-rated executive functioning (EF) in 6- to 18-year-old children adopted from psychosocially depriving institutions to that in children adopted from severely or "globally" depriving institutions. Individual continuity in EF over 2 years was examined in children adopted from psychosocially depriving institutions. There were 471 children adopted from psychosocially depriving Russian institutions that provided adequate physical resources but failed to provide a consistent set of responsive caregivers. There were 111 children adopted in the early 1990s from globally depriving Romanian institutions that were characterized by physical deprivation as well as profound psychosocial neglect. Adoptive parents completed a background questionnaire and the Behavior Rating Inventory of Executive Function (BRIEF). Children adopted from globally depriving institutions had significantly higher levels of EF difficulties than children adopted from psychosocially depriving institutions. For both groups, adoption after 18 months of age was associated with higher levels of EF difficulties. Children adopted from globally depriving institutions had higher levels of EF difficulties than the BRIEF standardization sample at younger ages at adoption. There was moderate to strong continuity in EF difficulties over 2 years in children adopted from psychosocially depriving institutions. These findings suggest that more severe early deprivation may lead to a higher risk of later EF difficulties, which may persist over time.

Interleukin-31: its role in canine pruritus and naturally occurring canine atopic dermatitis.

BACKGROUND: Interleukin-31 (IL-31) is a member of the gp130/interleukin-6 cytokine family that is produced by cell types such as T helper 2 lymphocytes and cutaneous lymphocyte antigen positive skin homing T cells. When overexpressed in transgenic mice, IL-31 induces severe pruritus, alopecia and skin lesions. In humans, IL-31 serum levels correlate with the severity of atopic dermatitis in adults and children. HYPOTHESIS/OBJECTIVE: To determine the role of IL-31 in canine pruritus and naturally occurring canine atopic dermatitis (AD). ANIMALS: Purpose-bred beagle dogs were used for laboratory studies. Serum samples were obtained from laboratory animals, nondiseased client-owned dogs and client-owned dogs diagnosed with naturally occurring AD. METHODS: Purpose-bred beagle dogs were administered canine interleukin-31 (cIL-31) via several routes (intravenous, subcutaneous or intradermal), and pruritic behaviour was observed/quantified via video monitoring. Quantitative immunoassay techniques were employed to measure serum levels of cIL-31 in dogs. RESULTS: Injection of cIL-31 into laboratory beagle dogs caused transient episodes of pruritic behaviour regardless of the route of administration. When evaluated over a 2 h period, dogs receiving cIL-31 exhibited a significant increase in pruritic behaviour compared with dogs that received placebo. In addition, cIL-31 levels were detectable in 57% of dogs with naturally occurring AD (≥ 13 pg/mL) but were below limits of quantification (<13 pg/mL) in normal, nondiseased laboratory or client-owned animals. CONCLUSIONS: Canine IL-31 induced pruritic behaviours in dogs. Canine IL-31 was detected in the majority of dogs with naturally occurring AD, suggesting that this cytokine may play an important role in pruritic allergic skin conditions, such as atopic dermatitis, in this species.

The consequences of early institutionalization: can institutions be improved? - should they?

BACKGROUND AND SCOPE: The focus of this review is on institutionalized children, one of the most inequitably and severely treated groups of children. Although institutions vary, many share some common characteristics, including large groups, high children: caregiver ratios, many and changing caregivers, and caregiver-child interactions that lack warm, sensitive, contingently-responsive, and child-directed behaviors. Resident children develop poorly physically, mentally, and social-emotionally, but those adopted from institutions display substantial catch-up growth in many domains of development. If they are adopted at an early age, there have been no long-term consequences of institutionalization yet measured; but if institutionalization is prolonged, they display higher rates of long-term deficiencies and problems in many domains. METHODS: This review is based on a database search of the literature, focusing on the development of children while residents, and the development of post-institutionalized children who have been transitioned from institutions to family care. It also draws on the reports and findings of the St. Petersburg-USA Orphanage Intervention. FINDINGS: A combination of theories pertaining to attachment (especially caregiver attachment to the infant/toddler), chronic stress, and genetics may explain these outcomes. It appears that caregiver-child interactions are a major contributor to children's outcomes, and interventions in institutions that improve such interactions produce substantial increases in children's physical, mental, and social-emotional development, including for children with disabilities. CONCLUSIONS: Deinstitutionalization and the creation of comprehensive professional child welfare systems emphasizing family care alternatives is a preferred goal, but this is likely to take many low-resource countries decades to develop. If substantial numbers of children remain in institutions despite best efforts to find families for them, improving the institutions might help to provide all the children with the best care possible under the circumstances.

Potential Selective Responding in a Parent Questionnaire Study of Post-Institutionalized Children.

Selective responding bias, though under-researched, is of particular concern in the study of post-institutionalized children because many studies rely on mailed questionnaires and response rates are often low. The current study addresses the impact of selective responding in a single wave of data collection and in a multi-wave study. Participants were 121 parents from a larger four-wave study of post-institutionalized children, identified as Never Responders, Previous Responders (but not to the current wave), or Wave 4 Responders. Parents were telephoned and asked about their adopted child's family, school, peer, and behavioral adjustment. The children (47% male) ranged in age from 2 to 20 years (M = 10.79, SD = 4.59) and had been adopted between 5 and 54 months of age (M = 15.49, SD = 9.94). There were no differences in parent ratings of adjustment for a single wave of data collection; however, participants who never responded reported poorer family and peer adjustment than those who had responded to at least one wave of data collection. Within a single wave of data collection, there was no evidence that selective responding contributes much bias. Over a multi-wave study, however, results may under-represent adjustment difficulties, especially with family and friends.

Lack of Interference of Oclacitinib with the results of intradermal testing or allergen-specific IgE serology in Dermatophagoides farinae-sensitized beagle dogs.

Canine atopic dermatitis (AD) is associated with increased levels of allergen-specific IgE due to hyper-sensitization to environmental allergens. Intradermal testing (IDT) and allergen-specific IgE serology testing are often used to determine the allergens which elicit an IgE response in animals with a diagnosis of AD. The objective of this study was to determine the effects of oclacitinib on IDT and allergen-specific IgE serology testing using a laboratory model of house-dust mite sensitized Beagle dogs. Twenty-four (24) normal, healthy purpose-bred Beagle dogs were sensitized to house dust mites (HDM, Dermatophagoides farinae) and randomly assigned to placebo-, oclacitinib- (0.4 mg/kg/dose PO), or prednisolone-treated (0.5 mg/kg/dose PO) groups. After 14 days of twice daily dosing, the effects of prednisolone and oclacitinib were compared to placebo using baseline and post-dose IDT and allergen-specific IgE serum measurements. Sensitized dogs had increased circulating HDM-specific IgE for at least two weeks post-sensitization. Prednisolone significantly inhibited the measurable sensitivity of IDT, while oclacitinib did not. Neither prednisolone nor oclacitinib imposed significant effects on allergen-specific IgE serum levels, suggesting oclacitinib may have potential to be used in dogs concurrently undergoing intradermal skin testing and/or allergen-specific IgE serology testing without interference with test results.

Blending theory with practice: implementing kindergarten transition using the interactive systems framework.

The Interactive Systems Framework (ISF; Wandersman et al. in Am J Commu Psychol 41(3-4):171-181, 2008) was used to implement a kindergarten transition demonstration project collaboratively developed by elementary and early education providers, community-based family and housing services, parents, and a University intermediary and technical assistance group. First person accounts from stakeholders at all levels provide a complementary and broad perspective on the project's implementation. The practice model blended existing research on kindergarten transition and parent involvement with feedback from stakeholders to create a community-specific program designed to help all children make a smooth entry into kindergarten. During implementation, evidence-based approaches needed to be adjusted to fit the specific needs of each community. Using the ISF as a guide, next steps and lessons learned include increasing leadership through a district-wide plan that is still flexible within each school community, increasing information and supports to individual schools, and improving data collection for continuous program improvement.

The role of transitions to new age groups in the development of institutionalized children.

Children in two institutions in St. Petersburg (Russian Federation) experienced ward transitions, one in which caregivers were trained to provide sensitive, responsive caregiving and one that conducted business as usual. A third institution eliminated transitions, received the same training, and implemented a variety of structural and employment changes designed to promote improved caregiver-child interactions and relationships. While the no-transition comprehensive intervention group of children steadily improved in Battelle Developmental Inventory (LINC Associates, 1988) scores across all age intervals, the children in the institution who encouraged some positive caregiver-child interactions improved before and after, but not during, an age period that involved a transition. In contrast, the no-treatment group displayed no developmental changes across any age period with or without a transition. These results suggest that the common institutional practice of ward transitions to new peers and caregivers is potentially disruptive to infants' and toddlers' general development, but primarily in a context in which some degree of caregiver-child sensitive and responsive interactions are encouraged.

Case report: Improving quality of care in Kazakhstan institutions.

This project is a community case study implemented by local professionals and caregivers to improve the quality of caregiving in two Kazakhstan institutions for infants and toddlers. Local professionals first received comprehensive training by an international team experienced in relevant research-based practices, and then the locals trained institutional staff. Over nearly 2 years, one institution progressively implemented changes in three wards and the other institution in one ward. The changes attempted to make the institution more family-like (e.g., smaller groups and fewer and more consistent caregivers) and caregivers behave more parent-like (e.g., more warm, sensitive, responsive interactions and relationships) without changing nutrition or medical care. Of the 45 children given some exposure to the emerging new wards, 11 experienced the fully revised wards for at least 4 months during their first 2 years of life. They displayed substantial increases in their physical growth, especially those entering in their first year of life, in contrast to the unchanging developmental patterns of 165 children who were reared in the two institutions before the ward changes were made. Physical growth is a commonly used standard of developmental well-being in institutions. Research shows it is sensitive to infants' psychosocial environment, and improvements in physical growth are related to children's cognitive and social-emotional development. Although this pilot community case study had only a few infants fully exposed to the complete ward changes and lacked characteristics of a research experiment, these results are consistent with children's developmental improvements reported in larger scientific studies of similar interventions. This project is an example of how some research-based practices are likely to be implemented in communities in the future. Specifically, it shows that local communities can successfully improve the rearing conditions within institutions, which improve the children's development, and may contribute to the success of their subsequent foster placement and adoption.

Parent ratings of executive functioning in children adopted from psychosocially depriving institutions.

BACKGROUND: Previous studies have found that post-institutionalized (PI) children are particularly susceptible to attention problems and perform poorly on executive functioning (EF) lab tasks. METHODS: Parent ratings of EF were examined in 288 school-age and 130 preschool-age children adopted from psychosocially depriving Russian institutions that provided adequate physical resources but not one-on-one interactions with a consistent set of responsive caregivers. RESULTS: Results revealed a step-like association between age at adoption and EF deficits; school-age children adopted after 18 months of age had greater EF difficulties than younger-adopted children and the never-institutionalized normative sample. The onset of adolescence was associated with a greater increase in EF deficits for children adopted after 18 months than for younger-adopted children. Preschool-age children were not found to have greater EF difficulties than the normative sample. CONCLUSIONS: These findings suggest that prolonged early psychosocial deprivation may increase children's risk of EF deficits and that the developmental stresses of adolescence may be particularly challenging for older-adopted PI children.

Research, Practice, and Policy Perspectives on Issues of Children without Permanent Parental Care.

This chapter presents conclusions, trends, conceptual analyses, hypotheses, and speculations regarding some fundamental issues of research, practice, and policy that are largely unsettled or controversial. As such, the chapter is not a summary of Chapters 1-8, but rather contains interpretations and opinions of the author intended to elevate the priority of certain issues, suggest hypotheses to be studied, and propose practice and policy steps to be considered.

Sensitive Periods.

This chapter reviews sensitive periods in human brain development based on the literature on children raised in institutions. Sensitive experiences occur when experiences are uniquely influential for the development of neural circuitry. Because in humans, we make inferences about sensitive periods from evaluations of complex behaviors, we underestimate the occurrence of sensitive periods at the level of neural circuitry. Although we are most interested in complex behaviors, such as IQ or attachment or externalizing problems, many different sensitive periods at the level of circuits probably underlie these complex behaviors. Results from a number of studies suggest that across most, but not all, domains of development, institutional rearing limited to the first 4-6 months of life is associated with no significant increase risk for long-term adverse effects relative to non-institutionalized children. Beyond that, evidence for sensitive periods is less compelling, meaning that "the earlier the better" rule for enhanced caregiving is a reasonable conclusion at the current state of the science.

Children in Institutional Care: Delayed Development and Resilience.

Children exposed to institutional care often suffer from "structural neglect" which may include minimum physical resources, unfavorable and unstable staffing patterns, and social-emotionally inadequate caregiver-child interactions. This chapter is devoted to the analysis of the ill effects of early institutional experiences on resident children's development. Delays in the important areas of physical, hormonal, cognitive, and emotional development are discussed. The evidence for and against the existence of a distinctive set of co-occurring developmental problems in institutionalized children is weighed and found to not yet convincingly demonstrate a "post-institutional syndrome". Finally, shared and non-shared features of the institutional environment and specific genetic, temperamental, and physical characteristics of the individual child are examined that might make a crucial difference in whether early institutional rearing leaves irreversible scars.