Linking caregiving quality during infancy to brain activity in early childhood and later executive function.

There is no relationship more vital than the one a child shares with their primary caregivers early in development. Yet many children worldwide are raised in settings that lack the warmth, connection, and stimulation provided by a responsive primary caregiver. In this study, we used data from the Bucharest Early Intervention Project (BEIP), a longitudinal study of institutionally-reared and family-reared children, to test how caregiving quality during infancy is associated with average EEG power over the first 3.5 years of life in alpha, beta, and theta frequency bands, and associations with later executive function (EF) at age 8 years. The sample comprised 189 children (129 institutionally-reared; 60 family-reared) who contributed data on observed caregiving quality during infancy (baseline; average age of 22 months), resting EEG power at baseline, 30, and 42 months, and performance-based data on a series of EF tasks at 8 years. Using Bayesian estimation, observed caregiving quality at baseline was marginally linked with higher average alpha and beta power, and lower theta power, from baseline to 42 months. In turn, higher average beta power and lower average theta power were marginally associated with higher EF at 8 years. In indirect effects models, higher caregiving quality at baseline was associated with higher EF at 8 years, with a marginal indirect effect through average theta power from baseline to 42 months. Variation in the quality of the early caregiving environment may be associated with later executive function, which is partially underpinned by individual differences in brain activity during early childhood. RESEARCH HIGHLIGHTS: Examined associations between caregiving quality during infancy, brain activity during early childhood, and executive function during mid-childhood in sample of never-institutionalized and institutionally-reared children. Significant associations between higher quality caregiving during infancy and higher executive function during middle childhood. Marginal associations between caregiving quality during infancy and brain activity during early childhood. Marginal associations between brain activity during early childhood and executive function during mid-childhood.

Foster Care Leads to Lower Irritability Among Adolescents with a History of Early Psychosocial Deprivation.

Irritability reflects a propensity for frustration and anger, and is a transdiagnostic symptom of both externalizing and internalizing psychopathology. While early adverse experiences are associated with higher levels of irritability, experiences of early psychosocial deprivation and whether family-based placements can mitigate the impact on subsequent irritability, remain underexplored. The current study examined irritability in 107 16-year-olds with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 49 community comparison children. At age 16 years, irritability was assessed using parent- and self-report forms of the Affective Reactivity Index. Compared to community adolescents, those with a history of institutional care exhibited significantly elevated irritability levels. Among those who experienced institutional care, those randomized to foster care had lower levels of irritability compared to participants randomized to the care-as-usual group, and this effect persists after controlling for baseline negative emotionality. These findings suggest a causal link between high-quality foster care and lower irritability following psychosocial deprivation. Additionally, longer duration in institutional care and non-family placement at age 16 years were associated with higher levels of irritability, highlighting the role of caregiving in explaining variation in irritability in adolescence. Policies that support long-term, high-quality family placements for children without regular caregivers should be prioritized.

Effects of institutional rearing and foster care intervention on error monitoring and externalizing behaviors in adolescence.

Children raised in institutions display deficits in error monitoring and increased psychopathology. Deficits in error monitoring might be a pathway for the emergence of psychopathology in previously institutionalized adolescents. Here we investigate the impact of early psychosocial deprivation and a foster care intervention on error monitoring and its association with internalizing and externalizing behavioral problems in adolescence A modified Flanker task assessed error monitoring in 16-year-old adolescents from the BEIP. The ERN and mid-frontal theta power were computed as indices of neural responses of error monitoring. Adolescents who experienced early institutional rearing and were subsequently placed into foster care showed comparable behavioral (RT, accuracy) and neural (ERN, theta power) measures of error monitoring to their never institutionalized peers; whereas adolescents who received care as usual showed both perturbed behavioral performance and neural responses. Longer duration of institutional care was associated with a reduction in mid-frontal theta power. The results further demonstrated a link between error monitoring as measured by ERN and mid-frontal theta and externalizing-ADHD behavioral problems in adolescents who continued receiving care as usual. The results highlight the long-term positive impact of early foster care placement and perturbations due to prolonged institutional care in neural responses of error monitoring.

Resting brain activity in early childhood predicts IQ at 18 years.

Resting brain activity has been widely used as an index of brain development in neuroscience and clinical research. However, it remains unclear whether early differences in resting brain activity have meaningful implications for predicting long-term cognitive outcomes. Using data from the Bucharest Early Intervention Project (Zeanah et al., 2003), we examined the impact of institutional rearing and the consequences of early foster care intervention on 18-year IQ. We found that higher resting theta electroencephalogram (EEG) power, reflecting atypical neurodevelopment, across three assessments from 22 to 42 months predicted lower full-scale IQ at 18 years, providing the first evidence that brain activity in early childhood predicts cognitive outcomes into adulthood. In addition, both institutional rearing and later (vs. earlier) foster care intervention predicted higher resting theta power in early childhood, which in turn predicted lower IQ at 18 years. These findings demonstrate that experientially-induced changes in brain activity early in life have profound impact on long-term cognitive development, highlighting the importance of early intervention for promoting healthy development among children living in disadvantaged environments.

Current approaches and future directions for addressing ethics in infant and early childhood mental health.

In this paper, we consider whether the field of infant and early childhood mental health (IECMH) needs its own code of ethics. We begin by describing unique features of infant and early childhood mental health (IECMH) and the diverse strategies that the field has developed to address complex clinical dilemmas, among them workforce development, clinical supports, policy statements, and statements of ethical values. Because of the field's interdisciplinary nature, we also consider how various contributing professions and organizations address ethical issues. While these are important resources that can inform ethical decision-making, we identify some of the limitations of the current approaches. We argue that it is time for the field of IECMH to take an intentional, systematic approach to directly address the complex and unique ethical dilemmas faced by infant and early childhood mental health practitioners, and we grapple with some of the challenges developing such a code might entail. We suggest several avenues for better understanding the scope of ethical issues and ethical decision-making processes in IECMH that could be used to support developing an ethics code that is responsive to the unique and challenging world of infant and early childhood mental health.

En este estudio, consideramos si el campo de la salud mental infantil y la temprana niñez (IECMH) necesita su propio código de ética. Comenzamos describiendo características distintivas de la salud mental infantil y la temprana niñez (IECMH) y la diversidad de estrategias que el campo ha desarrollado para tratar los complejos dilemas clínicos, incluyendo el desarrollo de la fuerza laboral, los apoyos clínicos, las afirmaciones de las políticas, así como las afirmaciones de valores éticos. Debido a la naturaleza interdisciplinaria del campo, también consideramos cómo varias profesiones y organizaciones que aportan contribuciones tratan los asuntos éticos. Aunque estos son recursos importantes que pueden servir de apoyo para la toma de decisiones éticas, identificamos algunas de las limitaciones de los acercamientos en el presente. Sostenemos que es el momento de que el campo de IECMH asuma un acercamiento intencional, sistemático que directamente trate los complejos y distintivos dilemas que enfrentan quienes ejercen en la práctica profesional de la salud mental infantil y la temprana niñez, y nos enfrentemos con algunos de los retos que el desarrollo de tal código pudiera significar. Sugerimos varias maneras de comprender mejor el ámbito de los asuntos éticos y los procesos éticos de toma de decisiones en IECMH con el fin de apoyar un código de ética que tome en cuenta el distintivo y desafiante mundo de la salud mental infantil y la temprana niñez.

Dans cet article nous réfléchissons et étudions si le domaine de la santé mentale du nourrisson et de la petite enfance (IECMH) a besoin de son propre code d'éthique. Nous commençons par la description des traits uniques de la santé mentale du nourrisson et de la petite enfance (IECMH) et de la diversité de stratégies que notre domaine a développées afin de faire face à des dilemmes cliniques complexes, y compris pour ce qui concerne la formation du personnel, les soutiens cliniques, les déclarations de principes, et les déclarations de valeurs éthiques. Du fait de la nature pluridisciplinaire de notre domaine, nous évoquons également la manière dont différentes professions et différentes organisations qui contribuent à notre domaine abordent les problèmes éthiques. Sachant que ce sont là des ressources importantes qui peuvent informer nos décisions éthiques, nous identifions certaines des limitations des approches actuelles. Nous faisons valoir qu'il est temps que le domaine de l'IECMH aborde intentionnellement et systématiquement les dilemmes éthiques complexes et uniques auxquels font face les praticiens de la santé mentale du nourrisson et de la petite enfance, et nous nous attaquons à certains des défis qu'un tel code peut présenter. Nous suggérons plusieurs directions afin de mieux comprendre l'étendue des questions éthiques et des processus de prises de décision éthiques au sein de l'IECMH de façon à soutenir un code éthique qui est sensible au monde unique de la santé mentale du nourrisson et de la petite enfance ainsi qu'aux défis auxquels il fait face.

Maternal Childhood Maltreatment, Internal Working Models, and Perinatal Substance Use: Is There a Role for Hyperkatifeia? A Systematic Review.

The parent-infant relationship is critical for socioemotional development and is adversely impacted by perinatal substance use. This systematic review posits that the mechanisms underlying these risks to mother-infant relationships center on 3 primary processes: (1) mothers' childhood maltreatment experiences; (2) attachment styles and consequent internal working models of interpersonal relationships; and (3) perinatal substance use. Further, the review considers the role of hyperkatifeia, or hypersensitivity to negative affect which occurs when people with substance use disorders are not using substances, and which drives the negative reinforcement in addiction. The authors performed a systematic review of articles (published 2000-2022) related to these constructs and their impact on mother-infant relationships and offspring outcomes, including original clinical research articles addressing relationships between these constructs, and excluding case studies, reviews, non-human animal studies, intervention studies, studies with fewer than 30% female-sex participants, clinical guidelines, studies limited to obstetric outcomes, mechanistic/biological studies, and studies with methodological issues precluding interpretation. Overall 1844 articles were screened, 377 were selected for full text review, and data were extracted from 157 articles. Results revealed strong relationships between mothers' childhood maltreatment experiences, less optimal internal working models, and increased risk for perinatal substance use, and importantly, all of these predictors interacted with hyperkatifeia and exerted a marked impact on mother-infant relationships with less data available on offspring outcomes. These data strongly support the need for future studies addressing the additive impact of maternal childhood maltreatment experiences, suboptimal internal working models, and perinatal substance use, with hyperkatifeia as a potential moderator, and their interacting effects on mother-infant socioemotional outcomes.

Introduction to special section doing the "right" thing: Ethical issues in infant and early childhood mental health.

Introducción a la Sección Especial: Hacer lo 'correcto:' Asuntos éticos en la salud mental infantil y en la temprana niñez ética, salud mental infantil y en la temprana niñez, código de ética.

Introduction à la section spéciale: Faire ce qui est 'juste': questions éthiques en santé mentale du nourrisson et de la petite enfance.

Ethical dilemmas in infant mental health: Examples from child protection, home visiting, and medical contexts.

Infant mental health is explicitly relational and strengths based as a field. Ethical dilemmas in infant mental health have received insufficient attention at the level of infant mental health professionals (IMHP) and other professionals caring for infants who must grapple with questions of when caregivers and infants have conflicting interests. We present composite cases drawn from North American and Australian contexts, using three systems in which such conflicts may commonly manifest: child protection, home visiting, and medical settings. The field of infant and early childhood mental health (IECMH) should begin to discuss such dilemmas and how best to balance the needs of caregivers and infants when they are not well aligned.

Como campo profesional, la salud mental infantil se basa explícitamente en relaciones y puntos fuertes. Los dilemas éticos en el campo de la salud mental infantil no han recibido suficiente atención al nivel de los practicantes profesionales que luchan con preguntas de cuando quienes prestan el cuidado y los infantes tienen intereses que entran en conflicto. Presentamos casos compuestos tomados de contextos en Norteamérica y Australia, usando tres sistemas en los cuales tales conflictos pudieran comúnmente manifestar: protección infantil, visitas a casa y escenarios médicos. El campo de la salud mental infantil y la temprana niñez debe comenzar a hablar de tales dilemas y cómo equilibrar mejor las necesidades de quienes prestan el cuidado y de los infantes cuando ambos no se encuentran bien emparejados.

La santé mentale du nourrisson et de la petite enfance est explicitement relationnelle ainsi que basée sur les forces qui existent, en tant que domaine. Les dilemmes éthiques en santé mentale du nourrisson et de la petite enfance n'ont pas assez reçu d'attention au niveau des praticiens aux prises avec des questions ayant trait aux moments et situations où les personnes prenant soin des enfants et les nourrissons ont des intérêts qui sont en conflit. Nous présentons des cas complexes issus de contextes nord-américains et australiens, en utilisant trois systèmes au sein desquels de tels conflits peuvent se manifester : la protection de l'enfant, la visite à domicile, et le cadre médical. Le domaine de la santé mentale du nourrisson et de la petite enfance devrait commencer à discuter de tels dilemmes et de la meilleure manière d'équilibrer les besoins des personnes prenant soin des bébés et des bébés lorsqu'ils ne sont pas bien alignés.

A Comprehensive Multilevel Analysis of the Bucharest Early Intervention Project: Causal Effects on Recovery From Early Severe Deprivation.

OBJECTIVE: The Bucharest Early Intervention Project is the first randomized controlled trial of foster care as an alternative to institutional care. The authors synthesized data from nearly 20 years of assessments of the trial to determine the overall intervention effect size across time points and developmental domains. The goal was to quantify the overall effect of the foster care intervention on children's outcomes and examine sources of variation in this effect, including domain, age, and sex assigned at birth. METHODS: An intent-to-treat approach was used to examine the causal effects of the randomized controlled trial for 136 children residing in institutions in Bucharest, Romania (baseline age, 6-31 months) who were randomly assigned to either foster care (N=68) or care as usual (N=68). At ages 30, 42, and 54 months and 8, 12, and 16-18 years, children were assessed for IQ, physical growth, brain electrical activity (EEG), and symptoms of five types of psychopathology. RESULTS: Participants provided 7,088 observations across follow-up waves. Children assigned to foster care had better cognitive and physical outcomes and less severe psychopathology than did those who received care as usual. The magnitude of these effect sizes remained stable across development. The foster care intervention most influenced IQ and disorders of attachment/social relatedness. CONCLUSIONS: Young children benefit from placement in families after institutional care. The benefits of foster care for previously institutionalized children were remarkably stable across development.

The ethics of infant and early childhood mental health practice.

Ethics is concerned with the basis for moral judgments of "right" and "wrong" and is central to the clinical endeavor. Many clinicians integrate ethical estimations into their work without much conscious awareness. However, explicit use of ethical principles and frameworks can help navigate clinical decision-making when there is a sense of moral conflict or ambiguity about the "right" course of action. This article aims to highlight the key concepts and principles in clinical ethics as they apply to IECMH practice and stimulate a bigger conversation in the profession around how to support each other to maintain high ethical standards in working with young children and their families. Specifically, the authors consider the relevance of Beauchamp and Childress' four principles framework (respect for autonomy, beneficence, non-maleficence, and justice), and address some of the special ethical challenges in the field, namely, the vulnerability of the infant, the need for a competent workforce, caring for caregivers, and the problem of multiple patients. Finally, the role of infant rights is briefly explored, noting the significant interest and debate that has been generated by the publication of the World Association of Infant Mental Health's Position Paper on the Rights of Infants.

A la ética le concierne la base para los juicios morales de lo que está 'bien' y lo que está 'mal' y es esencial para la labor clínica. Muchos profesionales clínicos incorporan estimaciones éticas en su trabajo sin mucha percepción consciente. Sin embargo, el uso explícito de principios y marcos de trabajo éticos puede ayudar a guiar las tomas de decisiones clínicas cuando se trata de un sentido de conflicto o ambigüedad moral acerca del curso de acción 'correcto.' Este artículo se propone subrayar los conceptos y principios claves en la ética clínica tal como ellos se aplican a la práctica de IECMH y estimular una mayor conversación en la profesión sobre cómo apoyarse mutuamente para mantener altos estándares éticos al trabajar con niños pequeños y sus familias. Específicamente, los autores consideran la relevancia del marco de trabajo de los cuatro principios de Beauchamp y Childress (respeto a la autonomía, el beneficiar y no perjudicar, y la justicia), y abordan algunos de los retos éticos particulares en el campo, tales como la vulnerabilidad del infante, la necesidad de una fuerza laboral competente, el cuidar de quienes prestan el cuidado, así como los problemas de quienes usan los servicios múltiples. Finalmente, se explora brevemente el papel de los derechos del infante, notando el significativo interés y debate que ha generado la publicación del Informe de Situación sobre los Derechos del Infante por parte de la Asociación Mundial de Salud Mental Infantil.

Le parentage attentif (aussi connu en tant que réactivité) est un échange dynamique et bidirectionnel entre la dyade parent-enfant, et lié au développement social et cognitif de l'enfant. Les interactions optimales exigent une sensibilité et la compréhension des signaux qu'envoie l'enfant, une réaction au besoin de l'enfant, et une modification du comportement du parent afin de répondre à ce besoin. Cette étude qualitative a exploré l'impact d'un programme de visite à domicile sur les perceptions que se font les mère sur leur réactivité à leurs enfants. Cette étude fait partie d'une plus ample recherche appelée right@home, un programme de visite à domicile en Australie qui promeut l'apprentissage et le développement des enfants. Les programmes de prévention comme le right@home privilégient des groupes de population qui font face à une adversité socioéconomique et psychosociale. Ils offrent des opportunités de promouvoir le développement des enfants au travers de la valorisation des compétences de parentage et d'un accroissement du parentage attentif. Des entretiens semi-structuré ont été fait avec 12 mères, fournissant des informations sur leurs perceptions du parentage attentif. Quatre thèmes ont été extraits des données en utilisant une analyse thématique inductive. Ceux-ci ont indiqué que (1) la préparation au parentage perçue des mères, (2) la reconnaissance des besoins de la mère et de l'enfant, (3) la réponse aux besoins de la mère et de l'enfant, et (4) la motivation à parenter avec réactivité sont toutes estimées être importantes. Ces recherches soulignent l'importance d'interventions qui mettent l'accent sur la relation parent-enfant en augmentant les capacités de parentage et en promouvant le parentage attentif.

Family-based care buffers the stress sensitizing effect of early deprivation on executive functioning difficulties in adolescence.

We examined whether family care following early-life deprivation buffered the association between stressful life events (SLEs) and executive functioning (EF) in adolescence. In early childhood, 136 institutionally reared children were randomly assigned to foster care or care-as-usual; 72 never-institutionalized children served as a comparison group. At age 16 years, adolescents (n = 143; 54% female; 67.1% Romanian) self-reported recent SLEs, completed a battery of memory and EF tasks, and completed a go/nogo task in which mediofrontal theta power (MFTP) was measured using electroencephalogram. More independent SLEs predicted lower EF and more dependent SLEs predicted lower MFTP, but only among adolescents with prolonged early deprivation. Findings provide preliminary evidence that family care following early deprivation may facilitate resilience against stress during adolescence on EF.

Effects of foster care intervention and caregiving quality on the bidirectional development of executive functions and social skills following institutional rearing.

Institutional rearing negatively impacts the development of children's social skills and executive functions (EF). However, little is known about whether childhood social skills mediate the effects of the foster care intervention (FCG) and foster caregiving quality following early institutional rearing on EF and social skills in adolescence. We examined (a) whether children's social skills at 8 years mediate the impact of the FCG on the development of EF at ages 12 and 16 years, and (b) whether social skills and EF at ages 8 and 12 mediate the relation between caregiving quality in foster care at 42 months and subsequent social skills and EF at age 16. Participants included abandoned children from Romanian institutions, who were randomly assigned to a FCG (n = 68) or care as usual (n = 68), and a never-institutionalized group (n = 135). At ages 8, 12, and 16, social skills were assessed via caregiver and teacher reports and EF were assessed via the Cambridge Neuropsychological Test Automated Battery. Caregiving quality of foster caregivers was observed at 42 months. FCG predicted better social skills at 8 years, which in turn predicted better EF in adolescence. Higher caregiver quality in foster care at 42 months predicted better social skills at 8 and 12 years, and better EF at 12 years, which in turn predicted 16-year EF and social skills. These findings suggest that interventions targeting caregiving quality within foster care home environments may have long-lasting positive effects on children's social skills and EF.

Structure of Psychopathology in Romanian Preschool-Aged Children in an Epidemiological and a High-Risk Sample.

Objective: Research on bifactor models of psychopathology in early childhood is limited to community samples with little longitudinal follow-up. We examined general and specific forms of psychopathology within 2 independent samples of preschool-aged Romanian children. Within a sample with children exposed to psychosocial deprivation, we also examined antecedents and longitudinal outcomes of the general factor. Method: One sample consisted of 350 Romanian children (mean age = 39.7 months, SD = 10.9) from an epidemiological study; the second sample consisted of 170 Romanian children (mean age = 55.6 months, SD = 1.9) exposed to severe early-life deprivation, as well as community comparison children, with longitudinal follow-up at 8 and 12 years. Psychopathology symptoms were assessed through caregiver-reported structured clinical interviews. Results: An SI-1 bifactor model of psychopathology was supported in both samples and included specific factors for externalizing, internalizing, and disturbed relatedness symptoms. In the second sample, longer duration of psychosocial deprivation and lower-quality caregiving were associated with higher scores on the general and all specific factors. Higher scores on the general factor were associated with later cognitive function, competence, and psychopathology symptoms. Considering all factors together, only the general factor explained variance in later childhood outcomes and was slightly stronger compared to a total symptom count for some, but not all, outcomes. Conclusion: General psychopathology in early childhood explains meaningful variance in child outcomes across multiple domains of functioning in later childhood. However, important questions remain regarding its clinical utility and usefulness, given complex measurement and limited explanatory power beyond the more accessible approach of a total symptom count. Clinical trial registration information: The Bucharest Early Intervention Project; https://clinicaltrials.gov/; NCT00747396.

Romania's Abandoned Children: The Effects of Early Profound Psychosocial Deprivation on the Course of Human Development.

Understanding the impact that early psychosocial neglect has on the course of human development has implications for the millions of children around the world who are living in contexts of adversity. In the US, approximately 76% of cases reported to child protective services involve neglect; world-wide, there are more than 150 million orphaned or abandoned children, including 10.5 million orphaned because of COVID-19. In much of the world, children without primary caregivers are reared in institutional settings. We review two decades of research based on the only randomized controlled trial of foster care as an alternative to institutional care. We report that children randomly assigned to continued care as usual (institutional care) suffer from persistent deficits in social, cognitive, and emotional development, and show evidence of disruptions in brain development. By contrast, children randomly assigned to foster care show improvements in most domains of functioning, although the degree of recovery is in part a function of how old they were when placed into foster care and the stability of that placement. These findings have important implications for understanding critical periods in human development, as well as elucidating the power of the psychosocial environment in shaping multiple domains of human development.

Early deprivation alters structural brain development from middle childhood to adolescence.

Hypotheses concerning the biologic embedding of early adversity via developmental neuroplasticity mechanisms have been proposed on the basis of experimental studies in animals. However, no studies have demonstrated a causal link between early adversity and neural development in humans. Here, we present evidence from a randomized controlled trial linking psychosocial deprivation in early childhood to changes in cortical development from childhood to adolescence using longitudinal data from the Bucharest Early Intervention Project. Changes in cortical structure due to randomization to foster care were most pronounced in the lateral and medial prefrontal cortex and in white matter tracts connecting the prefrontal and parietal cortex. Demonstrating the causal impact of exposure to deprivation on the development of neural structure highlights the importance of early placement into family-based care to mitigate lasting neurodevelopmental consequences associated with early-life deprivation.

The Bucharest Early Intervention Project: Adolescent mental health and adaptation following early deprivation.

Over the last 20 years, we have learned much about the extent to which early-life deprivation affects the mental health of children and adolescents. This body of evidence comes predominantly from studies of children raised in institutional care. The Bucharest Early Intervention Project (BEIP) is the only randomized controlled trial designed to evaluate whether the transition to family-based foster care early in development can ameliorate the long-term impact of institutional deprivation on psychopathology during vulnerable developmental windows such as adolescence. In this review, we detail the extent to which early deprivation affects mental health during this period, the capacity of family-based care to facilitate recovery from early deprivation, and the mechanisms underpinning these effects spanning social-emotional, cognitive, stress, and neurobiological domains. We end by discussing the implications and directions for the BEIP and other studies of youth raised in institutions.

Foster care leads to sustained cognitive gains following severe early deprivation.

This study examined longitudinal data from the Bucharest Early Intervention Project, a randomized controlled trial of foster care as an alternative to institutional care following exposure to severe psychosocial deprivation. We report data from 135 participants assessed in early adulthood (age 18 y). We find that 16 y after randomization occurred, those who had been randomized to high-quality foster care had significantly higher IQ scores (9 points, 0.6 SD) than those randomized to care as usual. Mediation analyses provide evidence that the causal effect of the intervention on cognitive ability in early adulthood could be explained, in part, by higher-quality caregiving and attachment security. These findings indicate that early investment in family care as an alternative to institutional care leads to sustained gains in cognitive ability. Fostering caregiving relationships is a likely mechanism of the intervention. In addition, exploratory analyses indicate that stable placements throughout childhood are associated with the greatest long-term gains in cognitive ability. Whether early interventions for infants and young children lead to lasting change has significant implications for decisions to invest in programs aimed at improving children's developmental outcomes.

Countertransference in the Treatment of Maltreated Children and Families.

Homer's Odysseus was forced to sail through a straight between 2 terrifying monsters: Charybdis, a giant whirlpool that threatened to devour the ship and crew, and Scylla, a 6-headed monster with rows of sharklike teeth who devoured men whole if they came within her grasp. Similar to Odysseus, clinicians who are treating maltreated children and their families often find themselves attempting to navigate between polarized interests and dangerously intense reactions within themselves. Powerful feelings are often elicited by maltreated children and caregivers who have experienced intersecting layers of personal, intergenerational, and often historical traumas as well as by action or inaction of complex systems. Child protective services and juvenile/family courts-which have their own language, values, and priorities-make decisions for reasons that are distinct from and sometimes in conflict with the clinical perspective of child mental health professionals.1.

Caregiver regulation: A modifiable target promoting resilience to early adverse experiences.

BACKGROUND: Experiences of adversity in early life are associated with increased risk for negative outcomes; yet, the impact of early adversity on any given child is difficult to predict given the considerable heterogeneity in functioning found even among children with similar exposures. Thus, although early adversity is associated with increased risk for negative outcomes on average, many children are resilient. While researchers have highlighted individual differences in children's internal characteristics that may relate to risk and resilience, external characteristics of the environment that differ between children are mutable factors that are also important for understanding heterogeneity in children's outcomes. OBJECTIVE: We propose that caregiver regulation of children's emotions is a key modifiable feature of the environment that promotes resilience to and recovery from early adversity. Specifically, given the critical role of caregiver regulation of emotions in early life for children's ability to understand and recover from adverse experiences, we highlight three levels of intervention focused on fostering healthy development in young children by targeting the availability, consistency, and quality of caregiver regulation, respectively. RESULTS: We provide a classification system designed to guide decision making about the level of intervention needed to support a given child's needs in terms of ultimately supporting the goal of receiving effective caregiver regulation. IMPLICATIONS: This framework may be useful for guiding the priority of treatments, as well as making clear the needed menu of options to support children following adversity, in addressing specific concerns related to ensuring effective caregiver regulation to promote resilience. (PsycInfo Database Record (c) 2022 APA, all rights reserved).