[Oral language development in maltreated and foster children]. / Le développement du langage oral chez les enfants maltraités et placés.

Language disorders, which are still very poorly detected, are often present in abused children. While the consequences are well known and long-lasting, little is known about the development and specific characteristics of these children, depending on where they were placed, the type of abuse they suffered and the age at which they were placed. This finding led to a review of the literature aimed at better defining the state of knowledge on the subject, for the benefit of better detection and treatment.

Life-course trajectories of children through the U. S foster care system.

OBJECTIVE: Foster care is surprisingly commonplace in the United States, with more than one in twenty children experiencing placement in their lifetimes. Due to the complexity of foster care (e.g. age at contact, length of stay), we still lack a clear idea of how children move through the child welfare system. We pose the question, "do distinct typologies of system trajectories exist that may be used to inform policy analyses?" METHODS: We used child maltreatment reports and foster care case records for all U.S. children born in FY2006 and placed in care between birth and age 15. Using sequence analysis, we classified child-level system trajectories into distinct clusters. Then, we employed multilevel multinomial regression to explore child and system characteristics associated with each. RESULTS: Three typologies were identified: 1) early-entry-exit, 2) school-age-entry, and 3) late-entry. Early-entry-exit cases typically entered and left foster care before turning three, were frequently adopted, and had little ongoing system contact. School-age-entry children typically entered between ages 5-10, were in care for the shortest amount of time, and mostly exited to reunification. Late-entry children typically entered between ages 9-11, entered with substantial CPS history and remained in care into mid-adolescence. CONCLUSIONS: Our findings provide the first description of foster care trajectories in the US. Both practice and policy formulation can benefit from these empirically supported descriptions. Using such trajectory typologies, researchers can now explore how trajectories may predict wellbeing outcomes. We discuss how the differences among the typologies may inform identification of service needs and outcomes.

First evaluation of Eyberg Child Behavior Inventory for foster children in Japan.

BACKGROUND: Behavioral problems of foster children are an important issue for the maintenance of the foster care system, but they have not been adequately studied in Japan. We used the Eyberg Child Behavior Inventory (ECBI) to investigate behavioral problems among foster children and to examine associated factors. METHODS: Twenty-nine foster children and their foster parents and 479 non-foster children and parents were recruited for the foster and control groups, respectively. Both groups underwent statistical comparative analyses using data from their ECBI assessments. The ECBI has two scales: the Intensity Scale quantifies the severity of child behavioral problems, and the Problem Scale captures the caregiver's perceived difficulties handling each behavior. We conducted a retrospective investigation of the background of the foster parent-child pairs to explore potential causal relationships with behavioral problems. RESULTS: The mean intensity score for the foster group was significantly higher than that for the control group (p = 0.001). The mean problem scores for the foster group and the control group were not significantly different (p = 0.79). In the foster group, the retrospective investigation revealed two children with neurological or neurodevelopmental disorders, 17 with histories of abuse, and 10 with other issues. CONCLUSION: Intensity scores showed severe behavioral problems among foster children, perhaps caused by neurological disorders, abuse, parental mental health, or economic hardship. Problem scores showed no significant differences between groups. It can therefore be posited that foster parents might exhibit a more lenient parenting style when dealing with children who have a history of abuse by their biological parents.

Perceived social support: Measurement differences in youth residing in the community versus youth residing in foster care.

BACKGROUND: Social support is commonly examined as a protective factor for children with a history of child maltreatment, and it has been measured by self-report via the Social Support Scale for Children (SSSC). Although the SSSC has established adequate reliability and validity in community and clinical samples, its psychometric properties have yet to be assessed in a sample of foster care youth. OBJECTIVE: This study provided a psychometric comparison of the SSSC in youth residing in foster care with youth residing in the community. PARTICIPANTS AND SETTING: Participants were two, comparable samples of 214 youth participants residing in foster care and 163 youth participants from the community between the ages of 8-12 years. METHODS: Community participants were recruited from local middle schools, and an age-matched comparison sample from a larger study on youth in foster care was utilized for comparison. Youth self-reported across measures and provided demographic information. Confirmatory factor analysis was utilized to determine measurement model fit to the data, and invariance testing was conducted to compare measurement models across the samples. RESULTS: Differences between samples in the factor structure and item distribution of the SSSC emerged. Specifically, the community sample provided adequate fit to the original four-factor model (friend, classmate, teacher, parent) of the SSSC, whereas the foster sample required a three-factor model (combined friend and classmate constructs). The newly defined three-factor model provided significant associations with youth behavioral and emotional outcomes. CONCLUSIONS: Youth in foster care may perceive social support across sources differently from youth residing in the community.

Escuta clínica e o conto de fadas: relato de experiência no atendimento à criança institucionalizada / La escucha clínica y el cuento de hadas: relato de experiencia en el cuidado de niños institucionalizados / Clinical listening and the fairy tale: experience report in caring for institutionalized children / L'écoute clinique et le conte de fées: rapport d'expérience dans la prise en charge d'enfants institutionnalisés

A escuta clínica de crianças em contextos institucionais, como os serviços de acolhimento, tem suscitado debates no campo do Sistema Único de Assistência Social. Assim, o objetivo do presente estudo é relatar a experiência de atendimento à criança em acolhimento institucional. Reflete-se, pois, sobre a possibilidade da escuta clínica, a partir da utilização do conto de fadas como recurso terapêutico. Para tanto, apresenta-se fragmentos de um caso atendido, pela primeira autora, em uma instituição de acolhimento para crianças e adolescentes em um município do estado do Pará. Compreende-se que é possível a criação de espaços de falas, a partir de recursos favorecedores da expressão da criança (conto de fadas) em outros campos de atuação do psicólogo (acolhimento institucional), flexibilizando o enquadramento de atendimento na perspectiva da clínica psicanalítica e ampliada

La escucha clínica de los niños en contextos institucionales, como las guarderías, ha suscitado debates en el ámbito del Sistema Único de Asistencia Social. Así, el objetivo de este estudio es reportar la experiencia del cuidado de niños en instituciones de cuidado. Por tanto, reflexiona sobre la posibilidad de la escucha clínica, a partir del uso del cuento de hadas como recurso terapéutico. Por tanto, fragmentos de un caso atendido por el primer autor se presentan en un albergue para niños y adolescentes de un municipio del estado de Pará, favoreciendo la expresión del niño (cuento de hadas) en otros campos de trabajo del psicólogo (atención institucional), flexibilizando el encuadre del cuidado en la perspectiva de la clínica psicoanalítica y ampliada

The clinical listening of children in institutional contexts, such as childcare services, has raised debates in the field of the Unified Social Assistance System. Thus, the aim of this study is to report the experienceof caring for children in institutional care. Therefore, it reflects on the possibility of clinical listening, from the use of the fairy tale as a therapeutic resource. Therefore, fragments of a case attended by the first author are presented in a shelterfor children and adolescents in a municipality in the state of Pará. It's understood that it is possible to create spaces for speech, from resources that favor the child's expression (fairy tale) in other fields of activity of the psychologist (institutional care), making the framing of care in the perspective of psychoanalytic clinic and extended

L'écoute clinique des enfants dans des contextes institutionnels, tels que les services de garde d'enfants, a soulevé des débats dans le domaine du Système Unifié d'Assistance Sociale. Ainsi, le but de cette étude est de rapporter l'expérience de prise en charge d'enfants en institution. Dès lors, il réfléchit à la possibilité d'une écoute clinique, à partir de l'utilisation du conte de fées comme ressource thérapeutique. Par conséquent, des fragments d'un cas assisté par le premier auteur sont présentés dans un foyer pour enfants et adolescents dans une municipalité de l'État du Pará favorisant l'expression de l'enfant (conte de fées) dans d'autres domaines de travail du psychologue (soins institutionnels ), assouplir le cadrage des soins dans la perspective de la clinique psychanalytique et étendue

Predictors of quality of life among youths in foster care-a 5-year prospective follow-up study.

PURPOSE: Few studies have investigated possible predictors of positive outcomes for youths in foster care. The aim of this prospective follow-up study was to examine quality of life (QoL) among youths in foster care and to assess whether contextual and child factors predicted QoL. METHODS: Online questionnaires were completed by carers in Norway in 2012 (T1, n = 236, child age 6-12 years) and by youths and carers in 2017 (T2, n = 405, youth age 11-18 years). We received responses on 116 of the youths at both T1 and T2, and our final sample consisted of 525 youths with responses from T1 and/or T2. Child welfare caseworkers reported preplacement maltreatment and service use at T1. We assessed mental health and prosocial behavior at T1 by having carers complete the Strength and Difficulties Questionnaire and QoL at T2 with youth-reported KIDSCREEN-27. We analyzed the data using descriptive statistics, t-tests and multiple linear regressions, and we used multiple imputation to handle missing data. RESULTS: Youths in foster care had lower QoL across all dimensions compared to a Swedish general youth sample. QoL scores among our sample were similar to Norwegian youths with ill or substance abusing parents and to European norm data. Youths reported the highest QoL scores on the parent relations and autonomy dimension. Male gender, younger age, kinship care and prosocial behavior five years earlier predicted higher QoL. CONCLUSION: Similar to other at-risk youths, youths in foster care seem to have lower QoL than the general Scandinavian population. Despite early adversities, they had good relations with their current carers. Adolescent girls seem especially vulnerable to low QoL and might need extra support to have good lives in foster care.

Developmental and behavioral profile in a domestic adoptees sample: a new challenge for the pediatrician.

BACKGROUND: The aim of this study is to investigate the changes of developmental and behavioral profile in a domestic adoptees sample. METHODS: Thirty-six domestic adoptive families were recruited, resulting in a sample of 39 children. Families were sent a general questionnaire for collecting data related to the children demographic variables, infant's background (time spent in institutional care, age at adoption), children's health status and anthropometric measures at T0, T1, T2, and T3. Moreover, the Infant Behavior Questionnaire-Revised Very Short Form and a modified version of parent-report of Child Behavior Checklist were used to assess temperament and to detect behavioral problems. RESULTS: As regards the psychopathological evaluation, behavior problems were more common in older children, especially among girls. In particular they exhibited a higher frequency of internalizing problems versus externalizing. CONCLUSIONS: Children in foster care suffer discontinuity of care that negatively affects their emotional and physical development. It is important for pediatricians to be aware of the special needs of adopted children, providing adequate support to adoptive families.

Psychological Wellbeing of Vulnerable Children During the COVID-19 Pandemic.

BACKGROUND: A pandemic disaster has specific effects on mental health, however, little is known about those specific effects in children and adolescents. Thus, the aim of this study is to describe the psychological impact of the COVID-19 pandemic on a sample of children and adolescents and to compare the results with previous national data and other studies to determine variations. METHOD: A total of 459 children and adolescents in residential care, foster families, kinship families, or family strengthening programs under SOS Children's Villages Spain were evaluated using the SDQ to measure internalizing and externalizing problems and using KIDSCREEN-10 index to measure heath related quality of life. An independent sample t-test, one-way ANOVA and the chi-square test were used. RESULTS: The children and adolescents in this study had worse psychological wellbeing than those in the 2017 Spanish reference, that is, before the COVID-19 outbreak. Quality of life remained the same. No differences between care modalities were found. CONCLUSION: It is necessary to monitor the mental health status of children and adolescents to prevent possible problems. Additionally, it is necessary to use well-known assessment instruments because it is essential to have a reference to other situations and populations.

Hearing the voices of looked-after children: Considering the challenges of obtaining feedback on healthcare services.

The voices of looked-after children (LAC) are rarely heard in health services or research. Obtaining feedback on services from children and adolescents and involving them in decision-making is important; yet communicating with vulnerable groups, like LAC, is not straightforward. Improving communication practices and ways of gaining feedback can facilitate quality improvement across healthcare. Using focus groups with 49 LAC aged 5-17 years, we identified three core themes. First, feedback tools need to be child-centred and LAC-friendly; second, tools should be gender-neutral and developmentally appropriate; and third, the current UK feedback tool was not fit for purpose. If feedback tools for children and adolescents are unfit for purpose, then any quality improvement and changes to services made are not sufficiently paying attention to this important population.

Moderating the Risk for Attention Deficits in Children with Pre-Adoptive Adversity: The Protective Role of Shorter Duration of out of Home Placement and Children's Enhanced Error Monitoring.

Early institutional-deprivation has been found to increase risk for inattention/hyperactivity (ADHD). Notably, studies suggest that children with a history of adversity evidencing an enhanced ERP (the error-related-negativity; ERN) may be protected against attention problems. However, such protective effects of the ERN have been studied in children whom typically experienced residential instability. It is unknown whether error-monitoring is similarly protective for children with stable post-deprivation placements. The present study examined the protective effect of the ERN in a sample of children who experienced at least 3-years of stable, relatively enriched caregiving after being internationally-adopted as infants/toddlers from institutional-care. We included two groups of children adopted internationally before age three, one group adopted from institutional-care (PI:n = 80) and one comparison group adopted from foster-care (FC;n = 44). A second comparison group consisted of non-adopted children (NA;n = 48) from demographically comparable families. At five-years of age, we assessed child ADHD symptoms (parent-report) and behavioral performance and neural correlates of error-monitoring (Go/No-Go task). PI children displayed lower Go/No-Go accuracy relative to FC children, and higher levels of ADHD symptoms relative to NA controls. In both FC and PI groups, longer duration of pre-adoptive out-of-home placement was associated with inattention, especially for children with deficits in error-monitoring. Enhancing cognitive control in the form of error monitoring might be a useful intervention target to protect children from some of the negative outcomes associated with adverse early care. Furthermore, results underscore that regardless of type of pre-adoptive care, we should aim to place children in stable/permanent homes as early as possible.

Perspective matters: Differences between child- and caregiver-reports of emotion regulation mediating the relationship between cumulative childhood trauma and mental health problems in foster children.

BACKGROUND: Cumulative childhood trauma predicts mental health problems in children, mediated by emotion regulation (ER). To assess trauma history and mental health in children, different informants may be addressed, assessing data from different perspectives. Despite differences between child- and caregiver-reports as robust finding in child psychology, it remains unclear to which extent perspective matters when examining these variables and related associations. OBJECTIVE: The current study was set to (1) examine whether ER mediates the relationship between cumulative childhood trauma and mental health problems in children, (2) test whether results differ with examined perspective, and (3) investigate if meaningful patterns of child-caregiver-reported discrepancies can be identified. METHODS: Data were collected from 145 children living in foster care by child- and caregiver-reports using standardized measures to assess trauma history (CTQ), ER (FEEL-KJ), and mental health problems (CBCL). Mediation and latent profile analysis were calculated. RESULTS: Mediation analysis identified ER as mediator for internalizing and externalizing mental health problems. Using data from different perspectives, mediation models differed considerably regarding significance, direction, and magnitude of effects. Using latent profile analysis, meaningful patterns of child-caregiver-reported discrepancies were identified and associated with children's sociodemographic and psychopathological characteristics. CONCLUSIONS: Adaptive and maladaptive ER distinctively mediate the relationship between cumulative childhood trauma and mental health problems in children. Perspective matters when examining these variables and child- and caregiver-reports are not interchangeable. Practitioners and researchers should be aware of inherent limitations when using data from distinct perspectives. Informant discrepancies can carry meaning and should not be ignored, but examined and interpreted instead.

Measuring self-reported polyvictimization in foster youth research: A systematic review.

BACKGROUND: Youth who are or have been in foster care (foster youth) are at higher risk for adverse outcomes in early adulthood. As the importance and complexity of victimization experiences, including types, timing, and perpetrators, is better understood it is unclear whether or to what extent the research on foster youth assesses polyvictimization. Because many types of victimization, such as community violence, are under-reported or absent in the administrative data typically used for research with foster care populations, self-reports of victimization experiences are necessary to comprehensively assess polyvictimization. Polyvictimization places youth at increased risk for adverse outcomes, and yet is not widely measured in the foster youth population. This is likely in part due to the wide-use of administrative reports to assess maltreatment among research on foster youth which does not capture a full range of victimization experiences. OBJECTIVE: The aim of the present study was to systematically review and evaluate the measurement of self-reported polyvictimization with foster youth samples. METHODS: A search in Academic Search Premier, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences Collection, Social Work Abstracts, SociINDEX, and Scopus was conducted. Articles included peer-reviewed, quantitative research studies that measured self-reported victimization (including violence exposure and/or maltreatment) with foster youth samples between 1997-2017. In total, 1887 studies were identified and reviewed by two raters and of those 18 met the study criteria. RESULTS: Almost all of the included studies (n = 16) measured multiple types of victimization through self-report. The most common types of victimization measured were sexual abuse (n = 15), physical abuse (n = 14), and physical neglect (n = 11). Half of studies (n = 9) measured at least one non-maltreatment victimization experience, such as community violence exposure and/or dating violence. However, included studies rarely measured other aspects of victimization, such as timing of exposure (e.g., pre or during foster care), which research has identified as relevant to outcomes. CONCLUSIONS: This is the first systematic review to assess the measurement of self-reported polyvictimization in research with current or former foster youth. Given the limited comprehensive assessment of victimization, these findings support strong recommendations for developing or adapting polyvictimization measures specifically for foster youth so that the measures include child welfare-specific factors such as the timing and perpetration of victimization experiences.

Enhancing the Lives of Foster Youth with Behavioral Interventions.

As members of state-funded team to monitor psychotropic medication use and examine cost-effective methods for behavioral treatment in foster care, the authors review behavioral studies on interventions for foster youth who engage in challenging behavior. Four behavioral technologies-preference assessments, teaching procedures, functional behavioral assessment and intervention, and parent training-are discussed. Four case studies and behavioral data for foster youth treated using these technologies are provided. Finally, pediatric providers are encouraged to recommend a practitioner with specialized training in behavior analysis to foster parents if a child displays disruptive behavior.

The relationship between cumulative traumatic experiences and ICD-11 post-traumatic symptoms in children and adolescents in foster care: The mediating effect of sense of coherence.

BACKGROUND: Children and adolescents in foster care show a high prevalence of cumulative traumatic experiences (CTE), symptoms of posttraumatic stress disorder (PTSD) and symptoms related to disturbances in self-organization (DSO). PTSD and DSO constitute the ICD-11 diagnosis Complex PTSD (CPTSD). Sense of coherence (SOC) has been shown to alleviate the impact of CTE. OBJECTIVE: This study aimed to investigate the mediating role of SOC in the relationship between CTE, PTSD, and DSO. PARTICIPANTS AND SETTING: Trauma history (CTE), PTSD, DSO and SOC were assessed in a sample of 140 children and adolescents in foster care aged 10-18 using self-report questionnaires. METHOD: Mediation analysis determined the direct, indirect and total effect of the mediation of SOC in the relationship between CTE, PTSD and DSO. RESULTS: The results showed no mediation of SOC in the relationship between CTE and PTSD symptoms (indirect effect of b = -.001, 95 %CI: -.088-.086). However, SOC mediated the relationship between CTE and DSO symptoms (indirect effect b = .128, 95 %CI: 0.045-.211). CONCLUSIONS: Those results may point to a promotive function of SOC for the overall development and different areas of self-organization, but not for PTSD symptoms. It is possible that the influence of the trauma on symptoms of PTSD is too pervasive for the promotive function of SOC. The present findings strengthen the assumption that PTSD and DSO are separate second-order factors, which characterize different groups of trauma survivors. The present findings are vital to inform tailored prevention and intervention strategies for survivors of early CTE.

Potentially traumatic events in foster youth, and association with DSM-5 trauma- and stressor related symptoms.

BACKGROUND: In DSM 5, three disorders are related to trauma and/or maltreatment: Post-traumatic Stress Disorder (PTSD), Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) but how these disorders relate to each other and to traumatic events is unknown. OBJECTIVE: We examined 1. Prevalence of Potentially Traumatic Events (PTEs) and poly-victimization for youths in foster care. 2. Associations between single/multiple PTEs and PTSD, DSED, and the two symptom-clusters that constitute RAD: Failure to seek/accept comfort (RAD A), and Low social-emotional responsiveness/ emotion dysregulation (RAD B). PARTICIPANTS, SETTING AND METHODS: Foster youth 11-17 years (N = 303) in Norway completed The Child and Adolescent Trauma Screen. Foster parents completed the RAD and DSED Assessment interview. RESULTS: Foster youth reported experiencing, on average, 3.44 PTEs each (range 0-15, SD 3.33), and 52.9 % reported PTSD symptoms at or above clinical cut off. The PTE sum score was associated with the latent factors PTSD (r = .66, p < 0.001), RAD cluster B symptoms (Low social-emotional responsiveness / emotion dysregulation, r = .28, p < 0.001) and DSED (r = .11, p = 0.046), but not with RAD cluster A symptoms (Failure to seek/accept comfort). CONCLUSIONS: These findings raise new questions about the nature, mechanisms and timing of development of RAD and DSED. Maltreatment assessment needs to encompass a wide range of PTEs, and consider poly-victimization.

Translating and Implementing Evidence-Based Mental Health Services in Child Welfare.

Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent-child interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children's mental health research, services, and policy are discussed.

Children and Young People "In Care" Participating in a Peer-Mentoring Relationship: An Exploration of Resilience.

The aim of this study was to explore how a 1-year peer-mentoring relationship contributed to change in young women "in care." Twenty semistructured, one-to-one interviews were conducted with mentors (n = 11) and mentees (n = 9) recruited from two different London local authorities. Participants' accounts were interpreted through a developmental lens to uncover developmental aspects and locus mechanisms through which transformative change took place. Resilience as a healthy outcome was the result of the dual function the mentoring relationship performed. The mentoring relationship was protective against the risks associated with transitioning to independent living and/or adulthood, and promoted internal assets and competencies whereby the mentees' ability to resist them was enhanced. Establishing a trustworthy connection with a role model promoted developmental domains within mentees.

Validation of ICD-11 PTSD and complex PTSD in foster children using the International Trauma Questionnaire.

OBJECTIVE: ICD-11 introduces post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct trauma-related disorders. Using the International Trauma Questionnaire (ITQ) as disorder-specific measure, this study is the first to examine the factorial and construct validity of ICD-11 PTSD, CPTSD and the ITQs' applicability in children. METHODS: Two hundred and eight Austrian foster children completed a set of standardized measures. Excluding participants who reported not having experienced any kind of trauma, a final sample of 136 children completed the ITQ. Factorial and construct validity of ICD-11 CPTSD and psychometric properties of ITQ scales were assessed by factor analysis and latent class analysis. RESULTS: Confirmatory factor analysis supported the two-factor higher-order model of ICD-11 CPTSD in children by high factor loadings and excellent model fit. Reliability and regression analysis evidenced psychometric adequacy and discriminant validity of ITQ scales. Latent class analysis substantiated construct validity of ICD-11 CPTSD, identifying a CPTSD (22.8%), PTSD (31.6%) and low symptoms class (45.6%). The CPTSD class showed highest rates of childhood trauma, comorbid psychopathology and functional impairment. CONCLUSION: Factorial and construct validity of ICD-11 CPTSD was evidenced in children for the first time using precise descriptions of ICD-11 symptom content, supporting the reliability and validity of the ITQ in children.