Attachment insecurity moderates the link between maternal childhood neglect and postpartum bonding to the infant.

Mothers who experienced childhood neglect are at increased risk of parenting difficulties in adulthood, but adult attachment relationships may be protective. Eighty-eight postpartum women seeking outpatient psychiatric care completed self-report measures on adverse childhood experiences, adult attachment, mental health symptoms, and bonding. Beyond the effects of maternal mental health on bonding, childhood neglect predicted bonding difficulties only in mothers with more insecure attachments, suggesting adult attachment as a potential point of intervention to reduce the intergenerational transmission of risk.

Clinician Racial Biases: Preliminary Investigation on Predictors of Poor Therapeutic Alliance and Retention in Home Visiting Intervention Program.

BACKGROUND: Home visiting programs are effective in improving maternal-child health, and higher therapeutic alliance is associated with improved program retention and outcomes. Black, single, low-income mothers have a higher risk for poorer health outcomes in pregnancy and postpartum and for early termination of therapeutic services. OBJECTIVE: To examine associations between clinician and client alliance and social, economic, and racial demographics. METHODS: Mothers (N = 71) who were pregnant or had an infant (age < 24 m) receiving Infant Mental Health (IMH) services through community health service agencies and their clinicians (N = 50) completed the Scale to Assess Therapeutic Relationships (clinicians: STAR-C, clients: STAR-P) at 3-, 6-, 9-, and 12 months, and provided demographic information. RESULTS: Survival analysis showed those with higher alliance ratings, both client and clinician ratings, at the 3-month time-point were more likely to remain in treatment longer (for clients est = -1.67, p = .0017; for clinician est = -.75, p = .031). Controlling for clinician experience and frequency of reflective supervision, Black clinicians had higher alliance ratings than white clinicians, (b = 3.1 (1.6), p = .049). Neither clinician-client racial match nor client marital status predicted alliance. Black clinicians' ratings of alliance did not vary by client race, but white clinicians reported weaker alliance with their Black, relative to white, clients (ß = .40, p = .045). CONCLUSIONS: Weaker alliance reported by white clinicians with Black clients, coupled with a lack of client-race related differences for Black clinicians, suggests white clinician racial bias may be important to consider in regards to program retention and health disparities.

From zero to thrive: A model of cross-system and cross-sector relational health to promote early childhood development across the child-serving ecosystem.

Early relational health between caregivers and children is foundational for child health and well-being. Children and caregivers are also embedded within multiple systems and sectors, or a "child-serving ecosystem", that shapes child development. Although the COVID-19 pandemic has made this embeddedness abundantly clear, systems remain siloed and lack coordination. Fostering relational health amongst layers of this ecosystem may be a way to systematically support young children and families who are facing adversity. We integrate theory, examples, and empirical findings to develop a conceptual model informed by infant mental health and public health frameworks that illustrates how relational health across the child-serving ecosystem may promote child health and well-being at a population level. Our model articulates what relational health looks like across levels of this ecosystem from primary caregiver-child relationships, to secondary relationships between caregivers and child-serving systems, to tertiary relationships among systems that shape child outcomes directly and indirectly. We posit that positive relational health across levels is critical for promoting child health and well-being broadly. We provide examples of evidence-based approaches that address primary, secondary, and tertiary relational health, and suggest ways to promote relational health through cross-sector training and psychoeducation in the science of early development. This model conceptualizes relational health across the child-serving ecosystem and can serve as a template for promoting child health and well-being in the context of adversity.

La salud de la temprana relación entre quienes prestan cuidado y los niños es fundamental para la salud y el bienestar del niño. Los niños y quienes les cuidan forman parte de múltiples sistemas y sectores, o un "ecosistema de servicio al niño," que moldea el desarrollo del niño. Aunque la pandemia del COVID-19 ha demostrado abundante y claramente esta pertenencia, los sistemas permanecen aislados y les hace falta coordinación. Fomentar la salud de la relación entre las capas del ecosistema pudiera ser una manera de apoyar sistemáticamente a los niños pequeños y familias que se enfrentan con situaciones adversas. Presentamos un modelo conceptual con base en marcos de trabajo de la salud mental infantil y la salud pública que ilustra cómo la salud de la relación a lo largo del ecosistema de servicio al niño pudiera promover el desarrollo del niño al nivel de grupo de población. Nuestro modelo articula cómo aparece la salud de la relación a lo largo de los niveles del ecosistema desde las relaciones entre quien presta el cuidado primario y el niño, hasta las relaciones secundarias entre quienes prestan el cuidado y loa sistemas de servicio al niño, y las relaciones terciarias entre sistemas que amoldan directa e indirectamente los resultados en el niño. Una positiva salud de la relación a través de todos los niveles es esencial para promover la salud y el bienestar del niño de manera amplia. Describimos ejemplos específicos de salud de la relación primaria, secundaria y terciaria, y sugerimos maneras de promover la salud de la relación a través del entrenamiento intersectorial y la educación sicológica dentro de la ciencia del desarrollo temprano. Este modelo conceptualiza la salud de la relación a lo largo del ecosistema de servicio al niño y puede ser un esquema patrón para promover el desarrollo del niño dentro del contexto de situaciones adversas.

La Santé Relationnelle Précoce entre les personnes prenant soin des enfants et les enfants est fondamentale pour la santé de l'enfant et son bien-être. Les enfants et les personnes prenant soin d'eux sont encastrés dans de multiples systèmes et des secteurs, ou un « écosystème ¼ servant l'enfant qui forme le développement de l'enfant. Bien que la pandémie du Covid19 ait rendu cet encastrement très clair, les systèmes demeurent compartimentés et manquent de coordination. Cultiver la santé relationnelle au sein des couches de l'écosystème pourrait s'avérer être une manière de soutenir des jeunes enfants et les familles faisant face aux obstacles. Nous présentons un modèle conceptuel informé par les structures de la santé mentale du nourrisson et de la santé publique qui illustre la manière dont la santé relationnelle au travers de l'écosystème servant les enfants peut promouvoir le développement de l'enfant au niveau de la population. Notre modèle articule ce à quoi la santé relationnelle ressemble au travers des niveaux de l'écosystème, des relations entre la personne principale qui s'occupe de l'enfant et l'enfant aux relations secondaires entre les personnes prenant soin de l'enfant et les systèmes servant l'enfant, jusqu'aux relations tertiaires entres les systèmes qui donnent forme aux résultats directement et indirectement. Une santé relationnelle positive au travers de tous les niveaux est critique pour la promotion de la santé de l'enfant et de son bien-être en général. Nous décrivons des exemples spécifiques de santé relationnelle primaire, secondaire et tertiaire, et suggérons des manières de promouvoir la santé relationnelle au travers de la formation entre secteurs et de la psychoéducation dans la science du développement précoce. Ce modèle conceptualise la santé relationnelle au travers de l'écosystème servant l'enfant et peut servir de modèle pour la promotion du développement de l'enfant dans le contexte de l'adversité.

Parenting and toddler self-regulation in low-income families: What does sleep have to do with it?

Toddlerhood is a sensitive period in the development of self-regulation, a set of adaptive skills that are fundamental to mental health and partly shaped by parenting. Healthy sleep is known to be critical for self-regulation; yet, the degree to which child sleep alters interactive child-parent processes remains understudied. This study examines associations between observed parenting and toddler self-regulation, with toddler sleep as a moderator of this association. Toddlers in low-income families (N = 171) and their mothers were videotaped during free play and a self-regulation challenge task; videos were coded for mothers' behavior and affect (free play) and toddlers' self-regulation (challenge task). Mothers reported their child's nighttime sleep duration via questionnaire. Results revealed significant Sleep × Maternal Negative Affect and Sleep × Maternal Negative Control interactions. Children who did not experience negative parenting had good self-regulation regardless of their nighttime sleep duration. For children who did experience negative parenting, self-regulation was intact among those who obtained more nighttime sleep, but significantly poorer among children who were getting less nighttime sleep. Thus, among children who were reported to obtain less nighttime sleep, there were more robust associations between negative parenting and poorer self-regulation than among toddlers who were reported to obtain more sleep.

Los primeros años de la niñez son un período sensible en el desarrollo de la auto-regulación, un grupo de habilidades adaptables que son fundamentales para la salud mental y a las que en parte les da forma la crianza. Es sabido que el dormir bien es esencial para la auto-regulación y, aun así, el nivel al que el sueño del niño altera los procesos interactivos entre progenitor y niño permanece poco estudiado. Este estudio examina las asociaciones entre la crianza observada y la auto-regulación del niño pequeño, tomando como moderador de tal asociación el proceso de dormir del niño pequeño. Se grabó en video a niños pequeños de familias de bajos ingresos (N=171) y sus madres durante una sesión de juego libre y una tarea de auto-regulación que suponía un reto; los videos fueron codificados en cuanto al comportamiento y afecto de las madres (juego libre) y la auto-regulación de los niños pequeños (tarea que suponía reto). Las madres reportaron acerca del sueño nocturno de sus niños por medio de un cuestionario. Los resultados revelaron interacciones significativas en cuanto al dormir y el negativo afecto materno, así como el dormir y el negativo control materno. Los niños que no experimentaron una crianza negativa tenían una buena auto-regulación independientemente de la duración de su sueño nocturno. En el caso de los niños que experimentaron una crianza negativa, la auto-regulación quedó intacta en aquellos que lograban más tiempo nocturno de dormir, pero fue significativamente más pobre en los niños que tenían menos tiempo de sueño nocturno. Por tanto, en el caso de los niños indicados en el reporte con menos tiempo de dormir nocturno, se dieron asociaciones más robustas entre la crianza negativa y una más pobre auto-regulación que entre los niños pequeños indicados en el reporte con más tiempo de dormir.

La petite enfance est une période sensible dans le développement de l'auto-régulation, un ensemble de compétences qui sont fondamentales pour la santé mentale et en partie formées par le parentage. L'on sait qu'un sommeil sain est critique pour l'auto-régulation et pourtant la mesure dans laquelle le sommeil de l'enfant altère les processus interactifs enfant-parent demeure peu étudiée. Cette étude examine les liens entre le parentage observé et l'auto-régulation du petit enfant, le sommeil de l'enfant ayant un effet modérateur dans ce lien. Des jeunes enfants de familles issues de milieux défavorisés (N=171) et leurs mères ont été filmés durant un jeu libre et un exercice de défi d'auto-régulation. Les vidéos ont été codées pour le comportement des mères et l'affect (jeu libre) et l'auto-régulation des jeunes enfants (exercice de défi). Les mères ont fait état de la durée de sommeil nocturne de leur enfant au moyen d'un questionnaire. Les résultats ont révélé que : sommeil significatif x l'affect négatif maternel et le sommeil x négatif maternel contrôle les interactions. Les enfants qui n'avaient pas fait l'expérience d'un parentage négatif avaient une bonne auto-régulation quelle qu'ait été la durée du sommeil nocturne. Pour les enfants ayant fait l'expérience d'une parentage négatif, l'auto-régulation était intacte chez ceux ayant plus dormi, mais bien moindre chez les enfants qui avaient moins dormi. Donc, chez les enfants ayant moins de sommeil nocturne les liens bien plus robustes ont été découverts entre le parentage négatif et une moindre auto-régulation que chez les petits enfants dormant plus durant la nuit.

Oxytocin and parenting behavior among impoverished mothers with low vs. high early life stress.

Recent work suggests that key aspects of sensitive parenting (e.g., warmth, emotional attunement) may be shaped in part by biology, specifically the neuropeptide oxytocin. However, some studies have found that oxytocin may not act in expected ways in higher-risk populations (e.g., those with postnatal depression or borderline personality disorder). This study examined the relation between oxytocin and parenting among mothers with varying levels of early life stress. Forty low-income mothers and their 34- to 48-month-old child participated in this study. Mother-child dyads were observed in an interaction task in their home, and videos of these interactions were later coded for parenting behaviors. Mothers' oxytocin production before and after the interaction task was assessed through saliva. Mothers' early stress was assessed via the Adverse Childhood Experiences Scale (ACES; Felitti et al. Am J Prev Med 14:245-258, 1998). For mothers with low ACEs, higher oxytocin secretion was associated with more positive parenting. For mothers with high ACEs, higher oxytocin secretion was associated with lower levels of positive parenting. Oxytocin may be operating differently for mothers who experienced harsh early social environments, supporting more defensive behaviors and harsh parenting than anxiolytic and prosocial behaviors.

Parent report measures of infant and toddler social-emotional development: a systematic review.

Background: Identifying young children at risk for socio-emotional developmental problems at an early stage, to prevent serious problems later in life, is crucial. Therefore, we need high quality measures to identify those children at risk for social-emotional problems who require further evaluation and intervention. Objective: To systematically identify parent report measures of infant and toddler (0-24 months) social-emotional development for use in primary care settings. Methods: We conducted a systematic review applying a narrative synthesis approach. We searched Medline, PsychInfo, Embase and SocIndex for articles published from 2008 through September 2015 to identify parent-report measures of infant and toddler social-emotional development. Data on the characteristics of the measures, including psychometric data, were collected. Results: Based on 3310 screened articles, we located 242 measures that were screened for eligibility. In all 18 measures of infant and toddler social-emotional development were included. Ten of the measures were developed specifically for measuring social-emotional development, and eight were measures including subscales of social-emotional development. The measures varied with respect to, e.g. the time of publication, number of items, age span, cost and amount of psychometric data available. Conclusions: Several measures of infant and toddler social-emotional development have been developed within the last decade. The majority of psychometric data are available through manuals, not peer-reviewed journals. Although all measures show acceptable reliability, the most comprehensive and psychometrically sound measures are the Ages and Stages Questionnaires: Social-Emotional-2, Infant-Toddler Social and Emotional Assessment, Brief Infant-Toddler Social and Emotional Assessment and Child Behaviour Checklist 1½-5.

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

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

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

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

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

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

Relationships reduce risks for child maltreatment: Results of an experimental trial of Infant Mental Health Home Visiting.

Background: Research examining the effectiveness of home visiting programs that reduce child maltreatment or associated risks yield mixed findings; some find positive significant impacts on maltreatment, whereas others find small to no effects. The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) is a manualized, needs-driven, relationship-focused, home-based intervention service that significantly impacts maternal and child outcomes; the effect of this intervention on child maltreatment has not been sufficiently evaluated. Objective: The current study examined associations between treatment and dosage of IMH-HV and child abuse potential in a longitudinal, randomized controlled trial (RCT). Participants and setting: Participants included 66 mother-infant dyads (Mother M age = 31.93 years at baseline; child M age = 11.22 months at baseline) who received up to 1 year of IMH-HV treatment (Mdn = 32 visits) or no IMH-HV treatment during the study period. Methods: Mothers completed a battery of assessments including the Brief Child Abuse Potential Inventory (BCAP) at baseline and at the 12-month follow-up assessment. Results: Regression analyses indicated that after controlling for baseline BCAP scores, those who received any IMH-HV treatment had lower 12-month BCAP scores compared to those who received no treatment. Additionally, participation in more visits was associated with lower child abuse potential at 12 months, and a reduced likelihood of scoring in the risk range. Conclusion: Findings suggest that greater participation in IMH-HV is associated with decreased risk for child maltreatment 1 year after initiating treatment. IMH-HV promotes parent-clinician therapeutic alliance and provides infant-parent psychotherapy which differentiate it from traditional home visiting programs.

Phenotypes of controlling feeding behaviours in mothers of toddlers: A mixed methods study.

BACKGROUND: Maternal feeding behaviours, in particular controlling behaviours, are associated with risk of childhood obesity. OBJECTIVES: To qualitatively examine patterns of mothers' beliefs and behaviours around controlling feeding through a semi-structured interview and to examine associations of those patterns with participant demographic characteristics and classical child feeding instruments. METHODS: A convenience sample of mothers (N = 35) of toddlers (mean age 25 months) participated in a semi-structured interview about their child feeding beliefs and behaviours. Anthropometrics were measured. Transcripts were analyzed using narrative analysis for patterns from which two emerged, known as phenotypes. A coding scheme was created and reliably applied. Bivariate correlates of the phenotypes with participant child characteristics and mother self-reported feeding behaviours were examined. RESULTS: The phenotypes were High Covert Control (n = 12) and Shared Control (n = 23). High Covert Control phenotype membership was correlated with higher child and mother BMI (body mass index) and child female sex. Shared Control phenotype membership was correlated with lower child and mother BMI and greater pressure to eat. CONCLUSIONS: Two controlling feeding phenotypes emerged among mothers of toddlers, which were associated with participant characteristics including BMI, but did not map onto classical child feeding instruments.

Associations between oxytocin receptor gene (OXTR) polymorphisms, childhood trauma, and parenting behavior.

Maternal oxytocin is connected to aspects of parenting including sensitivity, warmth, positive affect, and affectionate touch. Oxytocin receptor gene (OXTR) polymorphisms are associated with circulating oxytocin levels, altered brain activity, and parenting behaviors. This study aimed to replicate prior work on OXTR single-nucleotide polymorphisms (SNPs) rs1042778 and rs53576 in relation to maternal sensitivity, explore associations with other aspects of parenting (i.e., negative parenting), evaluate observational and self-report measures of parenting in relation to OXTR SNPs, and examine whether childhood trauma exposure moderates the relation between OXTR SNPs and parenting. Mothers (N = 100) were observed during 2 teaching interaction tasks with their 7-month-old infant, completed questionnaire and interview measures related to parenting and trauma history, and provided saliva specimens to derive OXTR genotypes. Mothers with OXTR rs1042778 TT genotypes demonstrated lower behavioral sensitivity, lower engagement, higher intrusiveness, and more frequent frightened/frightening behavior than mothers with TG or GG genotypes. Genotype interacted with childhood trauma history such that mothers who had experienced childhood trauma were more likely to demonstrate frightened/frightening behavior if they had the TT genotype on rs1042778 relative to the TG or GG genotype; however, small cell sizes for this interaction suggest replication is warranted. Contrary to expectations, mothers with the TT genotype on rs1042778 self-reported that they had less impaired bonding than mothers with TG or GG genotypes. Results are discussed with respect to prior work with oxytocin in lower versus higher risk samples, and the potential role of mothers' self-awareness in explaining discrepancies between results from observational versus self-report measures of parenting. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Development of children adopted to the United States following a social-emotional intervention in St. Petersburg (Russian Federation) institutions.

This study is a post-adoption follow-up of a social-emotional intervention in St. Petersburg, Russian Federation Baby Homes (BHs). Children previously resided in BHs and received Care as Usual (CAU, N=220), Training Only (TO, N=94), or Training plus Structural Changes (T+SC, N=45). This study examined intervention effects 0-6.5 years post-adoption to the USA, at age 9 months to 7 years old. Adoptive parents completed questionnaires on their child's social and behavioral development. Intervention graduates had better attachment security, less indiscriminate friendliness, and fewer behavior problems than CAU graduates. Children who had longer exposure to intervention conditions had better attachment security, but poorer executive function, externalizing and internalizing problems, and competence. Thus, although post-institutionalized children were generally functioning in the normal range in early childhood and effect sizes were small, a social-emotional intervention in institutions is associated with modest benefits to attachment and behavior problems and apparent decrements to executive function.

Early Caregiver-Child Interaction and Children's Development: Lessons from the St. Petersburg-USA Orphanage Intervention Research Project.

We review a series of interrelated studies on the development of children residing in institutions (i.e., orphanages) in the Russian Federation or placed with families in the USA and the Russian Federation. These studies rely on a single population, and many potential parameters that typically vary in the literature are similar across studies. The conceptual focus is on the role of early caregiver-child interactions and environmental factors that influence those interactions in children's development. Generally, children residing in institutions that provided minimal caregiver-child interactions displayed delayed physical, cognitive, and social-emotional development. Children and adolescents adopted from such institutions at 18 months of age or older had higher rates of behavioral and executive function problems, even many years after adoption. An intervention that improved the institutional environment by increasing the quality of caregiver-child interactions-without changes in nutrition, medical care, sanitation, and safety-led to substantial increases in the physical, cognitive, and social-emotional development of resident children with and without disabilities. Follow-up studies of children in this intervention who were subsequently placed with USA and Russian families revealed some longer-term benefits of the intervention. Implications are discussed for theoretical understanding of the role of early caregiver-child interactions in development as well as for practice and policy.

Intervention effects on reflectivity explain change in positive parenting in military families with young children.

Military families with young children often experience stress related to the unique circumstances of military families (e.g., deployment), and there is a need for interventions that are specifically tailored to military families with young children. The Strong Military Families (SMF) intervention responds to this need, and consists of two versions: A Multifamily Group (N = 34), and a Homebased psychoeducational written material program (N = 42; treated as the comparison group in this report). The Multifamily Group utilized an attachment-based parenting education curriculum and in vivo support of separations and reunions, encouraged peer support among parents, and connected families to additional services. In the present nonrandomized trial, we examine intervention effects on observed parenting behavior and affect, and test whether changes in parenting reflectivity account for intervention-related changes in observed parenting. Observed parenting behavior and affect were coded from the Caregiver-Child Structured Interaction Procedure (Crowell & Fleischmann, 1993), and parenting reflectivity was coded from the Working Model of the Child Interview (Zeanah & Benoit, 1995). Results suggest that relative to Homebased participants, Multifamily Group participants showed pre- and post- improvements in aspects of positive parenting (Emotional Responsivity, Positive Affect), but no decreases in negative parenting. The efficacy of the SMF Multifamily Group intervention does not appear to depend on parent risk level or preintervention parent behavior and affect. Further, a mediation model demonstrated that the intervention effects on parents' observed positive affect in an interaction task with their child were partially accounted for by intervention-related changes in their parenting reflectivity. (PsycINFO Database Record

The Development of Children Placed into Different Types of Russian Families Following an Institutional Intervention.

This study examined whether interventions in Russian Baby Homes promoting warm, sensitive, and responsive caregiver-child interactions and relationships would be associated with advantages in those children's behavior years after they transitioned to family care. Children (N = 135) who had resided for at least 3 months (M = 13.8 months) in one of three intervention institutions were subsequently placed in Russian families (relatives or non-relatives) for at least 1 year (M = 33.5 months). When children were 1.5-10.8 years of age, parents provided ratings of attachment, indiscriminate friendliness, executive functioning, social-emotional development, and behavior problems. Despite very substantial differences in the developmental status of children at departure from the three institutions, there were fewer than expected significant differences between children from the three institutions at follow-up or as a function of being placed with relatives or non-relatives. Specifically, children reared in the most improved institution displayed less indiscriminate friendliness, were less aggressive/defiant, and had less externalizing behavior. Children from all three institutions who were placed into families at older ages tended to be rated more poorly on some measures. These results suggest that previously institutionalized children adjust well to family life, but improved institutional caregiving can have some persistent benefits over several years in children transitioned to families.

Age at adoption from institutional care as a window into the lasting effects of early experiences.

One of the major questions of human development is how early experience impacts the course of development years later. Children adopted from institutional care experience varying levels of deprivation in their early life followed by qualitatively better care in an adoptive home, providing a unique opportunity to study the lasting effects of early deprivation and its timing. The effects of age at adoption from institutional care are discussed for multiple domains of social and behavioral development within the context of several prominent developmental hypotheses about the effects of early deprivation (cumulative effects, experience-expectant developmental programming, and experience-adaptive developmental programming). Age at adoption effects are detected in a majority of studies, particularly when children experienced global deprivation and were assessed in adolescence. For most outcomes, institutionalization beyond a certain age is associated with a step-like increase in risk for lasting social and behavioral problems, with the step occurring at an earlier age for children who experienced more severe levels of deprivation. Findings are discussed in terms of their concordance and discordance with our current hypotheses, and speculative explanations for the findings are offered.

Developmental relationships as the active ingredient: a unifying working hypothesis of "what works" across intervention settings.

Developmental relationships are characterized by reciprocal human interactions that embody an enduring emotional attachment, progressively more complex patterns of joint activity, and a balance of power that gradually shifts from the developed person in favor of the developing person. The working hypothesis of this article is that developmental relationships constitute the active ingredient of effective interventions serving at-risk children and youth across settings. In the absence of developmental relationships, other intervention elements yield diminished or minimal returns. Scaled-up programs and policies serving children and youth often fall short of their potential impact when their designs or implementation drift toward manipulating other "inactive" ingredients (e.g., incentive, accountability, curricula) instead of directly promoting developmental relationships. Using empirical studies as case examples, this study demonstrates that the presence or absence of developmental relationships distinguishes effective and ineffective interventions for diverse populations across developmental settings. The conclusion is that developmental relationships are the foundational metric with which to judge the quality and forecast the impact of interventions for at-risk children and youth. It is both critical and possible to give foremost considerations to whether program, practice, and policy decisions promote or hinder developmental relationships among those who are served and those who serve.