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.

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.

Investigating the causal relationship between maltreatment and cognition in children: A systematic review.

BACKGROUND: Cognitive impairment (i.e. lower IQ/cognitive development) in individuals who have experienced childhood maltreatment is well documented in the literature. It is not yet clear whether maltreatment itself causes cognitive impairment, or whether reduced cognitive functioning pre-dates maltreatment exposure and places children at risk of maltreatment. OBJECTIVE: This systematic review critically evaluated the evidence for a causal association between child maltreatment and impaired cognition in children under 12 years. METHODS: Following PRISMA guidelines, databases were searched and articles extracted according to inclusion criteria. Quality rating of articles was conducted independently by two reviewers and the evidence for a causal association was evaluated using guidelines based on the Hill criteria for causation in epidemiological and public health research. RESULTS: 31 articles were included in the review, with results that suggested lower IQ/cognitive development in maltreated children compared to controls, and a dose-response relationship between timing and duration of maltreatment and impaired cognition. Assessment of causality indicated strong evidence for a causal association between maltreatment and reduced overall cognitive performance in institutionalised children. Findings were less robust for non-institutionalised samples. Evidence regarding specific cognitive functions was mixed. CONCLUSIONS: Extreme maltreatment may lead to reduced cognitive functioning in children under 12 years. More research is required to determine the impact of the nature and timing of maltreatment, as well as additional heritable and social factors, on specific profiles of cognition in this population.

ANALYSIS OF FINE MOTOR CONTROL IN INSTITUTIONALIZED SHELTERED CHILDREN AND ADOLESCENTS THROUGH PERFORMANCE IN COMPUTER SOFTWARE.

OBJECTIVE: To analyze the psychomotor development and the fine motor control of institutionalized and non-institutionalized sheltered children and adolescents. METHODS: A cross-sectional study in which 54 subjects participated and were divided into two groups: 27 institutionalized sheltered children and adolescents (SG) and 27 non-institutionalized sheltered children and adolescents (CG). The psychomotor battery and the Learning and Motor Control software were used to evaluate development and motor control. The analysis of variance was performed for both groups with repetitive measurements for the last factor. RESULTS: The SG presented a total development score inferior to the CG, with differences in tonicity (p=0.041) and body awareness (p=0.039). The longest distance was performed on Task 1 (M=983.9 pixels; diagonal line; distance of 930.053 pixels), with no difference between the groups (p=0.64). Furthermore, the SG presented a greater average time in Task 1 (M=16.12 seconds) when compared with Tasks 2 (M=11.6 seconds; horizontal line; distance of 750 pixels) and 3 (M=10.6; vertical line; distance of 550 pixels), but only marginally different between Tasks 2 and 3 (p=0.055). Regarding the number of correct answers, the CG scored more (M=6.1) when compared with SG (M=4.6), with p<0.05. CONCLUSIONS: The institutionalized individuals showed a psychomotor development inferior to the CG. Furthermore, they presented impairment in fine motor control, covering a larger distance on the task that required the diagonal movement, longer execution time, less correct answers, and more errors.

Prevalence and number of children living in institutional care: global, regional, and country estimates.

BACKGROUND: Children living in institutionalised settings are at risk of negative health and developmental outcomes, as well as physical and emotional abuse, yet information on their numbers is scarce. Therefore, the aim of our study was to estimate global-level, regional-level, and country-level numbers and percentages of children living in institutional care. METHODS: In this estimation study, we did a systematic review of peer-reviewed publications and a comprehensive review of surveys and unpublished literature to construct a dataset on children living in institutional care from 136 countries between 2001 and 2018. We applied a wide range of methods to estimate the number and percentages of children living in institutional care in 191 countries in 2015, the year the Sustainable Development Goals were adopted. We generated 98 sets of estimates for each dataset, with possible combinations of imputation methods for countries with different available data points. Of these 98 sets, we report here five types of global-level estimates: estimates with the highest values, those with the lowest values, those with median values, those with uncertainty levels, and those derived from methods with the smallest root-mean-square errors (RMSE). FINDINGS: Global estimates of children living in institutions in 2015 was highly sensitive to the methods and data used, ranging from 3·18 million to 9·42 million children, with a median estimate of 5·37 million. When selecting the method with the lowest RMSE, the global estimate was 4·21 million, whereas with negative binomial regression with bootstrapping, the global estimate was 7·52 (95% CI 7·48-7·56) million. We also observed large variations in country-level estimates. Compared with other regions, estimates in south Asia, sub-Saharan Africa, and Latin America had larger variations in values when switching between estimation methods. High-income countries had the highest average prevalence of institutionalisation, whereas low-income countries had the lowest average prevalence. Estimates from the full data with the smallest RMSE method showed that south Asia had the largest estimated number of children living in institutions (1·13 million), followed by Europe and central Asia (1·01 million), east Asia and Pacific (0·78 million), sub-Saharan Africa (0·65 million), Middle East and North Africa (0·30 million), Latin America and the Caribbean (0·23 million), and North America (0·09 million). North America consistently had the lowest estimates among all regions. INTERPRETATION: Worldwide, institutional care places millions of children at elevated risk of negative health and developmental outcomes, highlighting the need for deinstitutionalisation. However, there is considerable uncertainty regarding the number of children living in institutions. To improve estimates of the size of this population, we need to standardise the definition of institutional care and improve data collection, particularly in countries with large child populations. FUNDING: Lumos Foundation.

A Systematic Review of the Outcome of Child Abuse in Long-Term Care.

The aim of the systematic review described in this article was to determine the outcome of child maltreatment in long-term childcare and the scope of the evidence base in this area. Searches of 10 databases were conducted. Forty-nine documents describing 21 primary studies and 25 secondary studies were selected for review. Searches, study selection, data extraction, and study quality assessments were independently conducted by two researchers, with a high degree of interrater reliability. Participants in the 21 primary studies included 3,856 abuse survivors and 1,577 nonabused controls. In six primary studies, survivors were under 18 years, and participants in the remaining primary studies were adults with a mean age of 54 years. Reviewed studies were conducted in the United Kingdom, the United States, Finland, Romania, Tanzania, Canada, Ireland, Australia, the Netherlands, Germany, Austria, and Switzerland. Participants were abused in religious and nonreligious residential care centers and foster care. There were significant associations between the experience of child abuse in long-term care and adjustment across the life span in the domains of mental health, physical health, and psychosocial adjustment. Evidence-based trauma-focused treatment should be offered to child abuse survivors. Future research in this area should prioritize longitudinal studies.

Analysis of fine motor control in institutionalized sheltered children and adolescents through performance in computer software / Análise do controle motor fino em crianças e adolescentes institucionalizados em abrigo por meio do desempenho em software de computador

ABSTRACT Objective: To analyze the psychomotor development and the fine motor control of institutionalized and non-institutionalized sheltered children and adolescents. Methods: A cross-sectional study in which 54 subjects participated and were divided into two groups: 27 institutionalized sheltered children and adolescents (SG) and 27 non-institutionalized sheltered children and adolescents (CG). The psychomotor battery and the Learning and Motor Control software were used to evaluate development and motor control. The analysis of variance was performed for both groups with repetitive measurements for the last factor. Results: The SG presented a total development score inferior to the CG, with differences in tonicity (p=0.041) and body awareness (p=0.039). The longest distance was performed on Task 1 (M=983.9 pixels; diagonal line; distance of 930.053 pixels), with no difference between the groups (p=0.64). Furthermore, the SG presented a greater average time in Task 1 (M=16.12 seconds) when compared with Tasks 2 (M=11.6 seconds; horizontal line; distance of 750 pixels) and 3 (M=10.6; vertical line; distance of 550 pixels), but only marginally different between Tasks 2 and 3 (p=0.055). Regarding the number of correct answers, the CG scored more (M=6.1) when compared with SG (M=4.6), with p<0.05. Conclusions: The institutionalized individuals showed a psychomotor development inferior to the CG. Furthermore, they presented impairment in fine motor control, covering a larger distance on the task that required the diagonal movement, longer execution time, less correct answers, and more errors.

RESUMO Objetivo: Analisar o desenvolvimento psicomotor e o controle motor fino de crianças e adolescentes institucionalizados e não institucionalizados em abrigo. Métodos: Estudo transversal, no qual participaram 54 indivíduos, divididos em dois grupos: 27 crianças e adolescentes institucionalizados em abrigo (GA) e 27 crianças e adolescentes não institucionalizados (GC) em abrigo. Para avaliação do desenvolvimento e controle motor, foram utilizadas a bateria psicomotora e o software Aprendizagem e Controle Motor. Foi realizada a análise de variância para os dois grupos com medidas repetidas para o último fator. Resultados: O GA apresentou pontuação total do desenvolvimento inferior ao GC, com diferença na tonicidade (p=0,041) e noção corporal (p=0,039). A maior distância percorrida encontrada foi na Tarefa 1 (M=984,9 pixels; com reta diagonal; distância de 930,053 pixels), sem diferença entre os grupos (p=0,64). Além disso, o GA apresentou tempo médio da Tarefa 1 (M=16,1 segundos) superior às Tarefas 2 (M=11,6 segundos; reta horizontal; distância de 750 pixels) e 3 (M=10,6 segundos; reta vertical; distância de 550 pixels), mas apenas marginalmente diferente entre as Tarefas 2 e 3 (p=0,055). Já em relação ao número de acertos, o GC apresentou mais acertos (M=6,1) comparado ao GA (M=4,6), com p<0,05. Conclusões: Os indivíduos institucionalizados apresentaram desenvolvimento psicomotor inferior ao GC, além de comprometimento no controle motor fino com maior distância percorrida na tarefa que exigia o movimento em diagonal, maior tempo na execução, menos acertos e mais erros.

Disinhibited Social Engagement Disorder in Early Childhood Predicts Reduced Competence in Early Adolescence.

Psychosocial deprivation is associated with the development of socially aberrant behaviors, including signs of disinhibited social engagement disorder (DSED). In longitudinal studies, signs of DSED have been shown to decrease over time, especially as children are removed from conditions of deprivation. What is less clear is whether signs of DSED in early childhood are associated with poorer functioning in early adolescence, including among children who no longer manifest signs of DSED at this age. In a sample of 136 Romanian children from the Bucharest Early Intervention Project (BEIP), who were exposed to early psychosocial deprivation in the form of institutional care, we examined caregiver-reported (ages 30, 42, and 54 months and 12 years) and observer-rated (age 54 months) signs of DSED. Competent functioning in early adolescence (age 12 years) was assessed across seven domains (i.e., family relationships, peer relationships, academic performance, physical health, mental health, substance use, and risk-taking behavior). A diagnosis of DSED in early childhood was associated with reduced competence in early adolescence. Furthermore, this association was significant even when signs of DSED diminished by age 12 years. We conclude that signs of DSED in early life are associated with reduced likelihood of competent functioning many years later in adolescence, even if signs of the disorder remit.

A cross sectional study to evaluate the oral health status of children with intellectual disabilities in the National Capital Region of India (Delhi-NCR).

BACKGROUND: Children with intellectual disabilities (ID) have usually been reported to have poorer levels of oral hygiene and higher prevalence of dental caries than their compeers. The present study was conducted to assess the status of dental caries and oral hygiene in different categories of institutionalised children with ID (syndromic and non-syndromic) registered in various special schools of Delhi (National Capital Region, India). METHODS: The present cross sectional study was conducted on 269 children [52 with cerebral palsy (CP), 35 with Down syndrome (DS), 30 with autism and 152 with non-syndromic intellectual disability] attending nine special schools who were examined for dental caries [Decayed, Missing and Filled Teeth index for permanent teeth (DMFT); decayed, missing/indicated for extraction, filled index for primary teeth (dmft) and prevalence of caries] and oral hygiene status [Oral Hygiene Index-simplified (OHI-S)]. The levels of disability were classified according to Stanford Binet scale as severe (IQ ≤ 35), moderate (IQ = 36-51) and mild (IQ = 52-67). Statistical analysis was performed using one way analysis of variance and post hoc test to compare the levels between groups at a significance level of P < 0.05. RESULTS: Mean DMFT, dmft and OHI-S indices scores for all the children irrespective of the category and the level of ID were 2.12 ± 1.95, 0.97 ± 1.60 and 2.05 ± 1.07, respectively. As the level of ID increased among these children, the mean DMFT index and OHI-S index increased with no significant effect on dmft. However, children with severe ID had higher OHI-S and DMFT scores than children with mild or moderate ID. The dental caries prevalence was 86.53%, 68.57%, 76% and 86.18% in children with CP, DS, autism and non-syndromic intellectual disability, respectively. CONCLUSIONS: The level of caries in permanent teeth and oral hygiene deteriorated with the increasing severity of ID as indicated by DMFT and OHI-S scores (severe > mild, moderate). However, the level of caries (dmft) was not affected by the level of ID in primary dentition. The prevalence of dental caries was highest among children with CP and least among children with DS.

Dimensionality of Early Adversity and Associated Behavioral and Emotional Symptoms: Data from a Sample of Japanese Institutionalized Children and Adolescents.

Recent approaches have begun to identify common variance across co-occurring childhood adversities (CAs) and their associations with symptoms of psychopathology. However, few studies have investigated these questions in high-risk samples, and in different cultural contexts. This study examined common variance amongst 18 types of CAs and associated symptomatology in 457 children and adolescents living in 24 residential homes in Japan. Principal component analysis identified four significant components that explained 35.1% of the variance: parental abuse, parental psychosocial risks, parental absence, and parental neglect. Path analysis revealed general as well as differential associations with negative outcomes: parental abuse, parental neglect, and parental psychosocial risks significantly associated with conduct problems, whereas parental abuse uniquely associated with peer problems, and parental neglect with hyperactivity/inattention. As well as confirming prior knowledge, these findings also extended understanding of these associations to a new cultural context. Future studies should take into account the multidimensional nature when assessing CAs.

The prevalence of mental disorders among children and youth staying in residential institutions, children's homes - a review of epidemiological studies. / Rozpowszechnienie zaburzen psychicznych wsród dzieci i mlodziezy przebywajacych w placówkach opiekunczo-wychowawczych, domach dziecka ­ przeglad badan epidemiologicznych.

Emergence of mental health problems in childhood can seriously affect further development of a man and thus hamper his adaptation to adult life. Children in residential institutions may be particularly vulnerable at risk of abnormal mental development, this includes so-called 'children's homes'. In the article we present an overview of the few studies carried out so far in the European residential institutions, including children's homes, over the years 1940-2011 in the UK, Germany, Romania, and Poland. Firstly, we briefly describe a classic research carried out in the world in the 1940s among children from children's homes. Secondly, we present a study conducted in the UK among children and youth from different age groups staying in residential institutions, including children's homes. Then we focus on studies carried out among children and adolescents form German residential institutions and on a group of preschool children from Romanian children's homes. At the end of the article we describe the first epidemiological study carried out in Poland on the population of children and young people staying in children's homes in Warsaw. The review of researches shows that children from day-care facilities are a population with a high prevalence of psychiatric disorder. Children and youth staying in residential institutions probably require specialized psychiatric, psychological and psychotherapeutic care.

Course of Disinhibited Social Engagement Disorder From Early Childhood to Early Adolescence.

OBJECTIVE: Disinhibited social engagement disorder (DSED) is poorly understood beyond early childhood. The course of DSED signs in a sample of children who experienced severe, early deprivation from early childhood to early adolescence was examined using variable-centered (linear mixed modeling) and person-centered (growth mixture modeling) approaches. METHOD: The study included 124 children with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 69 community comparison children matched by age and sex. DSED signs were assessed at baseline (mean age 22 months), 30, 42, and 54 months of age, and 8 and 12 years of age using a validated caregiver report of disturbed attachment behavior. RESULTS: Variable-centered analyses based on intent-to-treat groups indicated that signs of DSED decreased sharply for children randomized to foster care and decreased slightly but remained high for children randomized to care as usual. Person-centered analyses showed 4 profiles (i.e., elevated, persistent modest, early decreasing, and minimal). Elevated and persistent modest courses were associated with greater placement disruptions (F3,99 = 4.29, p = .007, partial eta-squared [η2] = 0.12), older age at placement into foster care (F3,56 = 3.41, p < .05, partial η2 = 0.16), and more time in institutional care (F3,115 = 11.91, p < .001, partial η2 = 0.24) compared with decreasing and minimal courses. CONCLUSION: Early and sustained placement into families after deprivation is associated with minimal or decreasing signs of DSED across development. Shortening the amount of time children spend in institutions and preserving placements could help decrease signs of DSED into early adolescence in previously institutionalized children.

Attention-Deficit Hyperactivity Disorder (ADHD) Symptoms in Children Adopted from Poland and their Atypical Association Patterns: a Bayesian Approach.

Although high rates of attention-deficit hyperactivity disorder (ADHD) symptoms have been observed among internationally adopted children, research on these symptoms in Polish adoptees is lacking. Therefore, we examined ADHD symptoms in Polish adoptees and their relationship to pre-adoptive risk factors, that is, time in institutional care, early deprivation, and prenatal alcohol exposure. We further compared the association patterns and gender distribution of ADHD symptoms in children adopted from Poland to those reported in the literature for ADHD symptoms in non-adopted children. Dutch adoptive parents of 121 Polish adoptees (52% boys; M age = 10.9 years, range 6.2-15.6; M ageadoption = 3.0 years, range 0.8-6.9) completed questionnaires regarding ADHD symptoms, pre-adoptive risk factors, attachment problems, conduct problems, and executive functioning deficits. Bayesian evaluation of informative hypotheses showed that Polish adoptees had increased levels of ADHD symptoms, compared to Dutch children in the general population. Time in institutional care, early deprivation, and prenatal alcohol exposure were not associated with ADHD symptoms. ADHD symptoms in Polish adoptees were more strongly associated with attachment problems and executive functioning deficits, but less strongly with conduct problems, compared to ADHD symptoms in non-adoptees. Furthermore, ADHD symptoms were more equally distributed among boys and girls than they are in non-adopted children. The findings indicate that Polish adoptees and their adoptive parents need special attention and support. The dissimilarities between ADHD symptoms in Polish adoptees and non-adoptees might indicate a different underlying causal mechanism, which may have important implications for clinical practice.

Remaking collective knowledge: An analysis of the complex and multiple effects of inquiries into historical institutional child abuse.

This article provides an overview and critical analysis of inquiries into historical institutional child abuse and examines their multiple functions and complex effects. The article takes a broadly international view but focuses primarily on Australia, the UK and Ireland, jurisdictions in which there have been major national inquiries. Drawing on sociological and other social science literature, it begins by considering the forms, functions, and purposes of inquiries. An overview of emergent concerns with institutional abuse in the 1980s and 1990s is then provided, followed by an examination of the response of many governments since that time in establishing inquiries. Key findings and recommendations are considered. The final sections of the article explore the evaluation of inquiries, both during their operation and in their aftermath. Policy change and legislative reform are discussed but the focus is on aspects often underplayed or overlooked, including an inquiry's credibility, its role in processes of knowledge production, and the part it plays in producing social and cultural shifts. In the context of growing numbers of inquiries across Western democracies, including the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, it is argued that grasping the complexity of the inquiry mechanism, with its inherent tensions and its multiple effects, is crucial to evaluating inquiry outcomes.

Adult disinhibited social engagement in adoptees exposed to extreme institutional deprivation: examination of its clinical status and functional impact.

BackgroundEarly-life institutional deprivation produces disinhibited social engagement (DSE). Portrayed as a childhood condition, little is known about the persistence of DSE-type behaviours into, presentation during, and their impact on, functioning in adulthood.AimsWe examine these issues in the young adult follow-up of the English and Romanian Adoptees study.MethodA total of 122 of the original 165 Romanian adoptees who had spent up to 43 months as children in Ceausescu's Romanian orphanages and 42 UK adoptees were assessed for DSE behaviours, neurodevelopmental and mental health problems, and impairment between ages 2 and 25 years.ResultsYoung adult DSE behaviour was strongly associated with early childhood deprivation, with a sixfold increase for those who spent more than 6 months in institutions. However, although DSE overlapped with autism spectrum disorder and attention-deficit hyperactivity disorder symptoms it was not, in itself, related to broader patterns of mental health problems or impairments in daily functioning in young adulthood.ConclusionsDSE behaviour remained a prominent, but largely clinically benign, young adult feature of some adoptees who experienced early deprivation.

The impacts of institutional child sexual abuse: A rapid review of the evidence.

While awareness of institutional child sexual abuse has grown in recent years, there remains limited understanding of its occurrence and outcomes as a distinct form of abuse. Drawing on research commissioned by the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, this article presents a rapid review of available evidence on the impacts of institutional abuse on victim/survivors. Literature searches identified 75 sources spanning international peer reviewed work and reports to Government that document or quantify the impacts of mostly historical child sexual abuse occurring in religious, educational, sporting and residential or out-of-home care settings. Consistent with child sexual abuse in other contexts, institutional child sexual abuse is found to be associated with numerous, pervasive and connected impacts upon the psychological, physical, social, educative and economic wellbeing of victims/survivors. Further, institutional child sexual abuse is associated with vicarious trauma at the individual, family and community level, and with impacts to the spiritual wellbeing of victims/survivors of abuse that occurs in religious settings. The identified literature suggests the trauma of institutional child sexual abuse may be exacerbated by the interplay of abuse dynamics in institutional settings, which may reduce or impede circumstances supporting disclosure, belief, support and protection from future harm. Acknowledging the limitations of the present study and the available evidence, this narrative synthesis provides insights into the complex impacts of institutional child sexual abuse.

Toward a more comprehensive analysis of the role of organizational culture in child sexual abuse in institutional contexts.

This article draws on a report prepared for the Australian Royal Commission into Institutional Responses to Child Sexual Abuse (Palmer et al., 2016) to develop a more comprehensive analysis of the role that organizational culture plays in child sexual abuse in institutional contexts, where institutional contexts are taken to be formal organizations that include children among their members (referred to here as "youth-serving organizations"). We begin by integrating five strains of theory and research on organizational culture from organizational sociology and management theory into a unified framework for analysis. We then elaborate the main paths through which organizational culture can influence child sexual abuse in youth-serving organizations. We then use our unified analytic framework and our understanding of the main paths through which organizational culture can influence child sexual abuse in youth-serving organizations to analyze the role that organizational culture plays in the perpetration, detection, and response to child sexual abuse in youth-serving organizations. We selectively illustrate our analysis with case materials compiled by the Royal Commission into Institutional Responses to Child Sexual Abuse and reports of child sexual abuse published in a variety of other sources. We conclude with a brief discussion of the policy implications of our analysis.

A study of associations among attachment patterns, maltreatment, and behavior problem in institutionalized children in Japan.

The present study investigates the relationships among children's history of maltreatment, attachment patterns, and behavior problems in Japanese institutionalized children. Twenty-nine children (12 boys and 17 girls) from three different institutions in the Kinki area (Western part of Japan) participated in this study. Their average age was 6. 41-years (ranging from 4 to 10). Thirteen of the children (44.8%) had history of maltreatment before they were institutionalized. Children's attachment was assessed by the Attachment Doll Play Assessment (George & Solomon, 1990, 1996, 2000). The child's main caregiver answered the Child Behavior Checklist (CBCL; Archenbach, 1991) to identify children's behavior problems. Results indicated a significant relationship between maltreatment history and attachment pattern. The relationship between attachment pattern and behavior problem was also confirmed. Implications and limitations of this study were discussed.

Estimating the number of children in formal alternative care: Challenges and results.

Given the relatively large body of literature documenting the adverse impacts of institutionalization on children's developmental outcomes and well-being, it is essential that countries work towards reducing the number of children in alternative care (particularly institutional care), and, when possible, reunite children with their families. In order to do so, reliable estimates of the numbers of children living in such settings are essential. However, many countries still lack functional administrative systems for enumerating children living outside of family care. The purpose of this paper is to provide a snapshot of the availability and coverage of data on children living in residential and foster care from some 142 countries covering more than 80 per cent of the world's children. Utilizing these country-level figures, it is estimated that approximately 2.7 million children between the ages of 0 and 17 years could be living in institutional care worldwide. Where possible, the article also presents regional estimates of the number of children living in residential and foster care. This work represents an important step to systematically identify and compile sources of data on children in alternative care and provides updated global and regional estimates on the magnitude of the issue. Its findings contribute to raising awareness of the urgent need to strengthen the capacity of countries to improve national systems for counting, monitoring and reporting on these vulnerable children.

Violence and alternative care: a rapid review of the evidence.

This paper focuses on the mechanisms through which international policy and practice relating to the safeguarding of children and young people living in alternative care is being implemented in national policy and practice. It is based on a rapid review of the evidence regarding the violence experienced by children and young people living in different forms of alternative care internationally. The evidence base indicates that children living in alternative care are especially vulnerable to violence and abuse, prior to and during their care experience and also in the longer term. The introduction of the UN Guidelines for the Alternative Care of Children has encouraged greater attention to this issue. The paper concludes that progress is variable according to a range of political, economic and social factors, and that greater attention to practice at national and community levels is required if more effective safeguarding practice is required. A more sophisticated evidence base is required to support this.