Attachment development in children adopted from China:The role of pre-adoption care and sensitive adoptive parenting.

The current study examined the attachment development of 92 internationally adopted Chinese girls, focusing on the influence of type of pre-adoption care (institutional versus foster care) and sensitive adoptive parenting. Although the children were more often insecurely attached than non-adopted children 2 and 6 months after adoption (Times 1 and 2, N = 92), they had similar levels of secure base script knowledge (SBS knowledge) as a non-adopted comparison group at age 10 (Time 3, N = 87). Furthermore, concurrently observed sensitive parenting was positively associated with SBS knowledge. Finally, a significant interaction between type of pre-adoption care and early-childhood sensitive parenting indicated that the post-institutionalized children showed a stronger increase in security than the post-foster children when parents were more sensitive.

A meta-analytic review of parenting interventions in foster care and adoption.

Foster and adoptive parents often face challenges while taking care of children who, due to their adverse early life experiences, are at risk of developing insecure attachment relationships, behavior problems, and stress dysregulation. Several intervention programs have been developed to help foster and adoptive parents to overcome these challenges. In the current study, a series of eight meta-analyses were performed to examine the effectiveness of these intervention programs on four parent outcomes (sensitive parenting, k = 11, N = 684; dysfunctional discipline, k = 4, N = 239; parenting knowledge and attitudes, k = 7, N = 535; parenting stress, k = 18, N = 1,306), three child outcomes (attachment security, k = 6, N = 395; behavior problems, k = 33, N = 2,661; diurnal cortisol levels, k = 3, N = 261), and placement disruption (k = 7, N = 1,100). Results show positive effects for the four parent outcomes and child behavior problems, but not for attachment security, child diurnal cortisol levels, or placement disruption. Indirect effects on child outcomes may be delayed, and therefore long-term follow-up studies are needed to examine the effects of parenting interventions on children.

The effectiveness of Video-feedback Intervention to promote Positive Parenting for Foster Care (VIPP-FC): study protocol for a randomized controlled trial.

BACKGROUND: Foster children are at higher risk of the development of behavior and emotional problems, which can contribute to the development of insecure attachment bonds with their foster parents and (subsequently) to placement breakdown. Sensitive parenting might minimize the adverse effects of the behavior and emotional problems. Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline in Foster Care (VIPP-FC) is an adaptation of the evidence-based Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) and aims at increasing sensitive parenting and the use of sensitive discipline strategies of foster parents. The current study is the first to examine the effectiveness of VIPP-FC. METHODS: A randomized controlled trial is used with 60 foster parent-child dyads (intervention group n = 30, control group n = 30). The primary outcomes are parental sensitivity, parental disciplining, and parental attitudes towards parenting. Data about attachment (in)security, behavioral and emotional problems, neurobiological parameters, and possible confounders is additionally collected. DISCUSSION: Examining the effectiveness of VIPP-FC contributes to the knowledge of evidence-based prevention and intervention programs needed in foster care practice. TRIAL REGISTRATION: NTR3899 .

Working with Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD): A case study.

Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), based on attachment theory and social learning theory, is an intervention aimed at enhancing sensitivity and firm limit setting in parents, and reducing behavior problems in children. The VIPP-SD program has been tested in populations of vulnerable children and parents at risk in twelve randomized controlled trials, and shows significant effects on both positive parenting and child outcomes. Here, we present a case study of an adoptive mother and her two-and-a-half-year-old adopted daughter. During the VIPP-SD program, including one introduction visit and six intervention sessions with video feedback, the mother-child interaction revealed important changes in positive parenting and child outcomes. By describing the intervention process in some detail we hope to shed light on how the VIPP-SD program can be used by clinicians and practitioners who support families in need of parenting support.

Pairing attachment theory and social learning theory in video-feedback intervention to promote positive parenting.

Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) is a social-learning and attachment-based intervention using video feedback to support sensitive parenting and at the same time setting firm limits. Empirical studies and meta-analyses have shown that sensitive parenting is the key determinant to promote secure child-parent attachment relationships and that adequate parental discipline contributes to fewer behavior problems in children. Building on this evidence, VIPP-SD has been tested in various populations of at-risk parents and vulnerable children (in the age range of zero to six years), as well as in the context of child care. In twelve randomized controlled trials including 1116 parents and caregivers, VIPP-SD proved to be effective in promoting sensitive caregiving, while positive social-emotional child outcomes were also found.

Effective preventive interventions to support parents of young children: Illustrations from the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD).

Secure attachment relationships are essential for children's current and later development. From attachment theory and research, it can be derived that sensitive parenting is the key to positive parent-child relationships. Is it possible to design effective interventions to enhance sensitive parenting? In this article, we review elements that are crucial for effective attachment-based interventions, and we proceed with illustrations from the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We describe how this intervention program was developed, how it has been implemented in practice in different types of families and in daycare settings, and how effective the program is. We conclude that intervention programs like the VIPP-SD could play an important role in the community by serving families in need of parenting support.

Do internationally adopted children in the Netherlands use more medication than their non-adopted peers?

UNLABELLED: Empirical evidence has shown that international adoptees present physical growth delays, precocious puberty, behavioral problems, and mental health referrals more often than non-adoptees. We hypothesized that the higher prevalence of (mental) health problems in adoptees is accompanied by elevated consumption of prescription drugs, including antidepressants, attention deficit hyperactivity disorder (ADHD) medication, and medication for growth inhibition/stimulation. In an archival, population-based Dutch cohort study, data on medication use were available from the Health Care Insurance Board by Statistics Netherlands from 2006 to 2011. The Dutch population born between 1994 and 2005 and alive during the period of measurement was included (2,360,450 including 10,602 international adoptees, of which 4447 from China). Their mean age was 6.5 years at start (range 1-12 years) and 11.5 years at the end of the measurement period (range 6-17 years). Chinese female adoptees used less medication for precocious puberty (as treatment for precocious puberty; odds ratio (OR) = 0.57, effect size Cohen's d = -0.31) and contraception (OR = 0.65, d = -0.24) than non-adoptees. For both males and females, non-Chinese adoptees used more medication for ADHD than non-adoptees (males: OR = 1.22, females: OR = 1.32), but the effect was small (males: d = 0.11, females: d = 0.15). CONCLUSIONS: Adoptees in the Netherlands generally do not use more medication than their non-adopted peers. WHAT IS KNOWN: • Meta-analytical evidence shows that international adoptees present physical growth delays and mental health referrals more often than non-adopted controls. • With the exception of one Swedish study on ADHD medication, there is no other systematic research on medication use of international adoptees. What is New: • All differences in medication use between international adoptees in the Netherlands and non-adopted controls were below the threshold of a small effect with the exception of medication for precocious puberty, but this effect was in the opposite direction with female adoptees using less medication for precocious puberty than non-adoptees. • International adoptees in the Netherlands do not use more medication despite experiences of preadoption adversity and higher rates of mental health referrals during childhood and adolescence.

[Attachment and Cognitive and Motor Development in the First Years after Adoption: A Review of Studies on Internationally Adopted Children from China]. / Bindung und kognitive sowie motorische Entwicklung in den ersten fünf Jahren nach der Adoption: Ein Review über international adoptierte Kinder aus China.

Due to early-childhood adversity, adopted children often display delays in their cognitive and motor development and have problems developing secure attachment relationships with their adoptive parents. In this review we present the results of all available studies on the attachment and the cognitive and motor development of internationally adopted children from China in the first years after arriving in the adoptive family. Seven pertinent studies were found, based on five samples examined in the USA, Canada, and the Netherlands. Regarding cognitive and motor development (five studies) the adoptees showed a delayed development at arrival in the adoptive family. As soon as six months after arrival the adoptees were, on average, functioning within normal ranges, although their catch-up to non-adopted children was not yet complete. Two years after arrival the catch-up to non-adopted peers appeared to be complete. Regarding attachment (two studies) observations of attachment six and twelve months after adoption showed less secure and more disorganized attachment for the adopted children compared to the normative distribution of non-adopted children. Two years after adoption, observations of attachment confirmed a catch-up in secure attachment, but the adoptees still displayed more insecure disorganized attachment than children in the norm group.

From maternal sensitivity in infancy to adult attachment representations: a longitudinal adoption study with secure base scripts.

We examined whether differences in adult attachment representations could be predicted from early and later maternal sensitivity, controlling for early and later assessments of attachment. In this longitudinal study on 190 adoptees, attachment at 23 years was measured with the Attachment Script Assessment. Maternal sensitivity was observed in infancy and at seven and 14 years. Attachment was also measured in infancy and at 14 years. Higher maternal sensitivity in infancy predicted more secure attachment in infancy and more secure attachment representations in young adulthood. Higher maternal sensitivity in middle childhood also predicted more secure attachment representations in young adulthood. There was no continuity of attachment from infancy to young adulthood, but attachment in adolescence and young adulthood were significantly related. Even in genetically unrelated families, maternal sensitivity in early and middle childhood predicts attachment representations in young adults, confirming the importance of sensitive parenting for human development.

Attachment and physiological reactivity to infant crying in young adulthood: dissociation between experiential and physiological arousal in insecure adoptees.

The associations between attachment representations of adopted young adults and their experiential and physiological arousal to infant crying were examined. Attachment representations were assessed with the Attachment Script Assessment (ASA), and the young adults listened to infant cries, during which ratings of cry perception were collected and physiological reactivity was measured. Secure adoptees showed a well-integrated response to infant distress: heart-rate increases and respiratory sinus arrhythmia (RSA) withdrawal were coupled with heightened perception of urgency in these individuals. In insecure adoptees RSA withdrawal was absent, and a combination of lowered perceived urgency and heightened sympathetic arousal was found, reflecting a deactivating style of emotional reactivity. Overall, our findings support the idea that internal working models of attachment explain individual differences in the way attachment-related information is processed.

What words cannot say: the telling story of video in attachment-based interventions.

In this Introduction to the Special Issue The Use of Video in Attachment-Based Interventions, we describe how film and video made their entry in attachment theory and research and ultimately in attachment-based interventions. The role of film in helping to understand attachment had its roots several decades ago with the Robertsons' footage as a memorable example, while the role of video in helping to support attachment in the context of intervention started later but quickly increased with the rapid growth of smaller video cameras. Today the use of video and video feedback in attachment-based interventions is common, with applications in home-visiting programs, clinical treatment and therapy, and training modalities for parent coaches. In this Special Issue we highlight current work in this field, including illustrative case studies, clinical descriptions and process evaluations as well as rigorous randomized controlled trials.

Race and bicultural socialization in the Netherlands, Norway, and the United States of America in the adoptions of children from India.

A cross-national sample of 622 internationally adopted children from India with White parents in The Netherlands (n = 409), Norway (n = 146), and the United States (n = 67) was used to contrast country-specific bicultural socialization (BCS) practices among families of transracial intercountry adoption. The 3 countries vary in their degrees of minority (US > Netherlands > Norway) and Indian populations (US > Norway > Netherlands). The current study examined parental survey trends among BCS practices, children's negative encounters about adoption, racial and positive discrimination, and parental worry about these issues. Country-specific differences were revealed: The United States and Norway (greatest Indian populations) reported the greatest similarity in BCS practices, classmates being a source of negative reactions/racial discrimination, and parental worry. The American sample encountered greater negative reactions to adoption from others; Dutch children experienced the least negative reactions from others overall, yet as in the United States (samples with the greatest minority heterogeneity) they still noted significant experiences of racial discrimination. Country-specific sociopolitical perceptions about adoption, ethnicity/race, and immigration are considered as factors that may have been used to inform parenting practices that facilitate children's biculturalism into family life (i.e., adoptive family stigma, percentages of Indian/minority populations, immigration policy trends). Concluding, cross-national research such as the current study may help intercountry adoption policymakers and practitioners to better understand and inform BCS practices in adoptive families.

The development of adolescents' internalizing behavior: longitudinal effects of maternal sensitivity and child inhibition.

Internalizing symptoms such as withdrawn and anxious-depressed behavior are common in adolescence. This prospective longitudinal study helps to gain insight into the development of internalizing behavior, focusing on the role of early parent-child interaction while ruling out genetic similarity as a confounder. More specifically, the central question addressed in this study was whether parental sensitivity and child inhibited temperament predict children's withdrawn and anxious-depressed behavior in middle childhood and adolescence. We followed 160 early-adopted children (53 % girls) from infancy to adolescence. Structural equation modeling was used to test relationships both prospectively and concurrently. The results revealed that more sensitive parenting in infancy and middle childhood predicted less inhibited behavior in adolescence, which in turn predicted fewer internalizing problems in adolescence. The findings suggest that maternal sensitivity lowers adolescents' inhibited behavior and decreases the risk for adolescents' internalizing problem behavior indirectly through lower levels of inhibition. Supporting sensitive parenting in the years before adolescence may protect children from developing inhibited behavior and internalizing behavior problems in adolescence.

Infants' responsiveness, attachment, and indiscriminate friendliness after international adoption from institutions or foster care in China: application of Emotional Availability Scales to adoptive families.

In a short-term longitudinal design we investigated maternal sensitivity, child responsiveness, attachment, and indiscriminate friendliness in families with children internationally adopted from institutions or foster care in China. Ninety-two families with 50 postinstitutionalized and 42 formerly fostered girls, aged 11-16 months on arrival, were studied 2 and 6 months after adoption. Maternal sensitivity and child responsiveness were observed with the Emotional Availability Scales, attachment was assessed with the Strange Situation procedure, and mothers reported on children's indiscriminate friendliness. The postinstitutionalized children showed less secure attachment, whereas the former foster children did not differ from the normative distribution of attachment security. However, at both assessments the two groups of adopted children showed more disorganized attachments compared to normative data. Adoptive mothers of postinstitutionalized and former foster children were equally sensitive and their sensitivity did not change over time. Postinstitutionalized and former foster children did not differ on indiscriminate friendliness, but children with more sensitive adoptive mothers showed less indiscriminate friendliness. The former foster children showed a larger increase in responsiveness over time than the postinstitutionalized children, suggesting that children's responsiveness is more sensitive to change than attachment, and that preadoption foster care is more beneficial for the development of children's responsiveness after adoptive placement than preadoption institutional care.

Remaining or becoming secure: parental sensitive support predicts attachment continuity from infancy to adolescence in a longitudinal adoption study.

In a longitudinal study with 125 early adopted adolescents, we examined continuity of attachment from infancy to adolescence and the role of parental sensitive support in explaining continuity or discontinuity of attachment. Assessments of maternal sensitive support and infant attachment (Strange Situation Procedure) were completed when infants were 12 months old. When the children were 14 years old, we observed mothers' sensitive support during a conflict discussion. The adolescents' attachment representations were assessed with the Adult Attachment Interview. Mothers of secure adolescents showed significantly more sensitive support during conflicts than did mothers of insecure adolescents. Overall, no continuity of attachment from infancy to adolescence was found. However, maternal sensitive support in early childhood and adolescence predicted continuity of secure attachment from 1 to 14 years, whereas less maternal sensitive support in early childhood but more maternal sensitive support in adolescence predicted children's change from insecurity in infancy to security in adolescence. We conclude that both early and later parental sensitive support are important for continuity of attachment across the first 14 years of life.

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.

Attachment and Emotional Development in Institutional Care: Characteristics and Catch-Up.

Attachment has been assessed in the extreme environment of orphanages, but an important issue to be addressed in this chapter is whether in addition to standard assessment procedures, such as the Strange Situation, the lack of a specific attachment in some institutionalized children should be taken into account given the limits to the development of stable relationships in institutionalized care. In addition, this chapter discusses disinhibited or indiscriminately friendly behavior that is often seen in institutionalized children. Enhanced caregiving quality alone appears to be insufficient to diminish indiscriminate behavior, at least in some children, as evidenced by the persistence of indiscriminate behavior in children adopted out of institutions into adoptive families. We suggest that the etiology and function of indiscriminate friendly behavior may be different for institutionalized versus not-institutionalized children. In the first case it may reflect a distortion or disruption of early attachment relationships, in the latter case it is likely to result from the lack of expected input in the form of contingent interactions with a stable caregiver in early life. We try to delineate infant and caregiver characteristics that are associated with secure attachment in institutional settings, given the inevitable fact that large numbers of infants worldwide are being raised, and will be raised, in contexts of institutional care. We conclude that much further study is needed of the development of children's attachments following adoption out of an institutional setting.

The importance of quality of care: effects of perinatal HIV infection and early institutional rearing on preschoolers' attachment and indiscriminate friendliness.

BACKGROUND: The rearing environment of human immunodeficiency virus (HIV)-infected children is often compromised, putting these children at additional risks. Positive caregiving may ameliorate the impact of adverse circumstances and promote attachment security. The goal of the present study was to examine the attachment relationships of HIV-infected children in biological families and institutions; to examine the effects of HIV infection and institutional rearing on attachment security and indiscriminate friendliness; and to assess the role of caregiving in the face of HIV-related adversities. METHODS: We studied 64 Ukrainian uninfected and HIV-infected children reared in families and institutions (mean age 50.9 months). Physical and cognitive development of children as well as attachment-related domains and indiscriminate friendliness were assessed. RESULTS: Institutional care but not the presence of HIV was associated with lower levels of attachment security and higher levels of indiscriminate friendliness. On average, the level of indiscriminate friendliness among institution-reared children was more than twice as high as among family-reared children. Only 24% of institution-reared children had clearly developed attachment patterns, as opposed to 97% among family-reared children. Controlling for physical and cognitive development, type of care (institution or family), and HIV status, positive caregiving was associated with higher levels of attachment security. Indiscriminate friendliness was associated with lower levels of attachment security among family-reared children, but with higher levels of positive caregiving among institution-reared children. CONCLUSIONS: Etiology and function of indiscriminate friendliness may differ for family-reared versus institution-reared children. The findings of this study suggest the necessity of early interventions improving the quality of care for HIV-infected children.

Effects of perinatal HIV infection and early institutional rearing on physical and cognitive development of children in Ukraine.

To study the effects of perinatal HIV-1 infection and early institutional rearing on the physical and cognitive development of children, 64 Ukrainian uninfected and HIV-infected institutionalized and family-reared children were examined (mean age = 50.9 months). Both HIV infection and institutional care were related to delays in physical and cognitive development, with a larger effect of the rearing environment. Family care, even of compromised quality, was found to be more favorable for children's physical and cognitive development than institutional care. The impact of the quality of child care on physical and cognitive development is discussed in light of future interventions.

Infants' physical and cognitive development after international adoption from foster care or institutions in China.

OBJECTIVE: To compare the physical, cognitive, and motor development of infants adopted from foster care with infants adopted from institutions. METHOD: Forty-two formerly fostered and 50 post-institutionalized girls adopted from China, aged between 11 and 16 months on arrival, were visited 2 and 6 months after adoption. Children's height, weight, and head circumference were measured. Stress regulation was assessed by diurnal salivary cortisol levels, and cognitive and motor development were assessed using the Bayley Scales of Infant Development-second edition. RESULTS: At both assessments, the (modest) physical growth delays were similar for formerly fostered and post-institutionalized children. For weight and head circumference (but not for height) a catch-up over time was found, with a significant interaction between time and age at arrival, showing a more rapid catch-up for earlier adopted children. The daily cortisol curves of the formerly fostered and post-institutionalized children were similar and did not change over time. At both assessments, the former foster children outperformed the post-institutionalized children on mental and motor skills. Both groups showed a similar catch-up for mental development. For motor development, no catch-up was found. CONCLUSIONS: The influence of pre-adoption foster versus institutional rearing seems more pronounced for cognitive and motor development than for physical development and hormonal stress regulation. Our outcomes suggest that pre-adoption foster care is less detrimental to children's cognitive and motor development than institutional rearing.