Wade M, et al. - Experts evaluated the trajectories of latent psychopathology factors—general (P), internalizing (INT), and externalizing (EXT)—among children reared in institutions. They also assessed whether or not randomization to foster care is related to reductions in psychopathology from middle childhood through adolescence. The transdiagnostic vulnerability to psychopathology was seen to be increased from childhood to adolescence with the institutionalization. This risk is partially mitigated by the early assignment to foster, thereby highlighting the importance of social enrichment in buffering the effects of severe early neglect on trajectories of psychopathology.

Methods

• Researchers conducted a longitudinal, intent-to-treat randomized clinical trial in Bucharest, Romania, where children residing in 6 institutions underwent baseline testing and were then randomly assigned to a care as usual group (CAUG) or a foster care group (FCG).
• They recruited a matched sample of a never-institutionalized group (NIG) to serve as a comparison group.
• The commencement of the study took place in April 2001, and the most recent (age 16 years) follow-up started in January 2015 and is ongoing.
• Intervention included the institutionally reared children randomized to high-quality foster homes.
• They measured the psychopathology using the MacArthur Health and Behavior Questionnaire.
• Symptoms of psychopathology in several domains were reported by the teachers and/or caregivers.

Results

• This analysis included a total of 220 children (50.0% female; 119 ever institutionalized) at the mean ages of 8, 12, and 16 years.
• A good fit to the data was offered by a latent bifactor model with general (P) and specific internalizing (INT) and externalizing (EXT) factors.
• Findings suggested that at age 8 years, CAUG (mean, 0.41; 95% CI, 0.17-0.67) and FCG (mean, 0.30; 95% CI, 0.04-0.53) had higher P than NIG (mean, -0.40; 95% CI, -0.56 to -0.18).
• FCG (mean, 0.07; 95% CI, -0.18 to 0.29) had lower P than CAUG (mean, 0.37; 95% CI, 0.13-0.60) by age 16 years.
• Compared with CAUG, who remained stably high over this period (slope, -0.02; 95% CI, -0.19 to 0.14), this effect was likely driven by modest declines in P from age 8 years to age 16 years among FCG (slope, -0.12; 95% CI, -0.26 to 0.04).
• Furthermore, CAUG and FCG demonstrated increasing divergence in EXT over time, such that FCG (mean, -0.30; 95% CI, -0.58 to -0.02) had fewer problems than CAUG (mean, 0.05; 95% CI, -0.25 to 0.36) by age 16 years.
• They did not observe any INT differences.