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Published Online: 1 May 2012

A Randomized Controlled Trial Comparing Foster Care and Institutional Care for Children With Signs of Reactive Attachment Disorder

Abstract

Objective:

The authors examined signs of emotionally withdrawn (inhibited type) and indiscriminately social (disinhibited type) reactive attachment disorder in Romanian children enrolled in a randomized trial of foster care compared with institutional care and in a comparison group of never-institutionalized children.

Method:

At baseline and when children were ages 30, 42, and 54 months and 8 years, caregivers were interviewed with the Disturbances of Attachment Interview to assess changes in signs of reactive attachment disorder in three groups of children: those receiving care as usual (including continued institutional care) (N=68); those placed in foster care after institutional care (N=68); and those who were never institutionalized (N=72). The impact of gender, ethnicity, and baseline cognitive ability was also examined.

Results:

On the Disturbances of Attachment Interview, signs of the inhibited type of reactive attachment disorder decreased after placement in foster care, and scores were indistinguishable from those of never-institutionalized children after 30 months. Signs of the disinhibited type were highest in the usual care group, lower in the foster care group, and lowest in the never-institutionalized group. Early placement in foster care (before age 24 months) was associated with fewer signs of the disinhibited type. Lower baseline cognitive ability was associated with more signs of the inhibited type in the usual care group and more signs of the disinhibited type in both groups.

Conclusions:

Signs of the inhibited type of reactive attachment disorder responded quickly to placement in foster care; signs of the disinhibited type showed less robust resolution with foster placement. Lower baseline cognitive ability was linked to signs of reactive attachment disorder.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 508 - 514
PubMed: 22764361

History

Received: 17 May 2011
Revision received: 7 October 2011
Revision received: 4 December 2011
Accepted: 18 December 2011
Published online: 1 May 2012
Published in print: May 2012

Authors

Details

Anna T. Smyke, Ph.D.
From the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; Department of Human Development, University of Maryland, College Park; Department of Pediatrics, Harvard Medical School, Boston; Department of Developmental Medicine, Children's Hospital Boston; and the Division of Child Psychiatry, UCLA School of Medicine, Los Angeles.
Charles H. Zeanah, M.D.
From the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; Department of Human Development, University of Maryland, College Park; Department of Pediatrics, Harvard Medical School, Boston; Department of Developmental Medicine, Children's Hospital Boston; and the Division of Child Psychiatry, UCLA School of Medicine, Los Angeles.
Mary Margaret Gleason, M.D.
From the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; Department of Human Development, University of Maryland, College Park; Department of Pediatrics, Harvard Medical School, Boston; Department of Developmental Medicine, Children's Hospital Boston; and the Division of Child Psychiatry, UCLA School of Medicine, Los Angeles.
Stacy S. Drury, M.D., Ph.D.
From the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; Department of Human Development, University of Maryland, College Park; Department of Pediatrics, Harvard Medical School, Boston; Department of Developmental Medicine, Children's Hospital Boston; and the Division of Child Psychiatry, UCLA School of Medicine, Los Angeles.
Nathan A. Fox, Ph.D.
From the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; Department of Human Development, University of Maryland, College Park; Department of Pediatrics, Harvard Medical School, Boston; Department of Developmental Medicine, Children's Hospital Boston; and the Division of Child Psychiatry, UCLA School of Medicine, Los Angeles.
Charles A. Nelson, Ph.D.
From the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; Department of Human Development, University of Maryland, College Park; Department of Pediatrics, Harvard Medical School, Boston; Department of Developmental Medicine, Children's Hospital Boston; and the Division of Child Psychiatry, UCLA School of Medicine, Los Angeles.
Donald Guthrie, Ph.D.
From the Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans; Department of Human Development, University of Maryland, College Park; Department of Pediatrics, Harvard Medical School, Boston; Department of Developmental Medicine, Children's Hospital Boston; and the Division of Child Psychiatry, UCLA School of Medicine, Los Angeles.

Notes

Address correspondence to Dr. Smyke ([email protected]).

Funding Information

Dr. Guthrie has served on data monitoring committees for Medtronic and the Department of Veterans Affairs and on several academic data and safety monitoring boards; he serves as a statistical consultant to several academic institutions; and he owns shares of Johnson & Johnson stock. The other authors report no financial relationships with commercial interests.

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