Predictive Associations Between Prenatal and Postnatal Risk Factors and Developmental and Temperamental Outcomes Among Infants in Foster Care

Infants detained for maltreatment present with a number of prenatal and perinatal risk factors, including prenatal exposure to substances, prematurity, low birth weight, birth complications, and prolonged hospital stay. These factors pose significant risk for a broad range of infant outcomes critically linked to later functioning, including cognitive, language, motor, socio-emotional, and temperamental development (Del Giudice, 2012; Singer et al., 2008). However, many infants exposed to prenatal risk also develop normatively, highlighting the need to better understand how the postnatal environment influences individual differences in response to prenatal risk. Importantly, prior to adoptive placement, infants placed in foster care often face unique stressors, including multiple foster placements and trial stays with birth families. Exposure to these pre-placement postnatal factors vary substantially across individuals, and they likely have unique and cumulative effects on developmental outcomes (Fisher et al., 2005; Waterman et al., 2013). Emerging evidence from normative samples suggests that prenatal and postnatal factors may interact to influence developmental outcomes, potentially through prenatal programming of infant responses to postnatal environments (Pluess & Belsky, 2011). These theoretical models have yet to be tested among infants in foster care, despite a need to better understand which prenatal and postnatal risk factors influence outcomes for these high-risk children. Thus, the present study aims to disentangle prenatal and postnatal risk factors to examine their unique and interactive associations with differentiated developmental outcomes (cognitive, language, motor, socioemotional) and early temperament among high-risk infants transitioning from foster care to adoption. Participants include 68 infants aged 0-28 months (race-ethnicity: 26% Hispanic, 14% African-American, 11% Caucasian, 1% Asian/Pacific Islander, 26% Mixed, 22% Unknown) referred for developmental assessment within two months of placement in adoptive homes. Prenatal/perinatal risk factors (prematurity, substance exposure, birth weight, birth complications, hospital stay) and postnatal risk factors (birth parent stay, age detained, number of placements, age at adoption) were coded from previous medical, DCFS, and court records. Infants were assessed using the Bayley Scales of Infant Development (BSID-III) to evaluate cognitive, motor (fine and gross), language (receptive and expressive), and socioemotional development. In addition, the primary adoptive parent completed the Infant/Toddler Temperament Questionnaire to measure temperament domains (e.g., sensitivity, reactivity, regularity). Preliminary correlations revealed that cognitive and motor development were most robustly associated with prenatal risk (i.e., prematurity, birth weight) and perinatal risk factors (i.e., birth complications, duration of hospital stay), whereas infant temperament domains were additionally linked to postnatal risk factors (i.e., birth parent placement, age detained, age of adoption, number of placements). Furthermore, differential associations between individual risk factors and outcomes were observed, suggesting there are likely unique risk factors predictive of different infant outcomes. Next, stepwise regressions will be employed to examine the independent, cumulative, and interactive associations between prenatal and postnatal risk factors on each developmental and temperamental outcome. Results will provide insight into the individual and cumulative effects of prenatal and preplacement postnatal risk factors for infants transitioning from foster care to adoption. Implications for key prevention and intervention targets among high-risk infants will be discussed

Prevenção seletiva da ansiedade e promoção da resiliência: resultados de um programa de resiliência e prevenção da ansiedade com meninas em risco

Introduction: Research has shown that the number of children and adolescents experiencing emotional difficulties such as anxiety is escalating, especially for those groups at risk. Living in an orphanage has been considered a risk factor for delays in an individuals’ social, emotional and behavioral development. Objective: The aim of this study was to evaluate the effectiveness of the Spanish version of the FRIENDS program, a CBT-based resilience program, with 57 girls from low socioeconomic status (SES) background that were living in an orphanage. Method: Participants received the program for 10 consecutive weeks, and pre- and post-test measures were collected.  Measures evaluated participants’ anxiety symptoms, level of self-concept, hope, coping skills, and psychosocial difficulties. Social validity was also assessed. Results: Results showed positive changes, including a decrease in anxiety symptoms and psychosocial difficulties, as well as an increase in their proactive coping skills. Several subscales and items of the self-concept and hope outcome measures also reported statistically significant improvements. Conclusions: Participants and parents/caregivers reported that the program was both enjoyable and useful. Implications of the findings and directions for further research are discussed.Introducción: Las investigaciones han demostrado que el número de niños y adolescentes que experimentan dificultades emocionales como la ansiedad va en aumento, sobre todo para los grupos en situación de riesgo. Vivir en un orfanato se ha considerado un factor de riesgo de retraso en el desarrollo social, emocional y conductual de un individuo.   Objetivo: El objetivo de este estudio era evaluar la eficacia de la versión en español del programa friends, un programa de resiliencia basado en la tcc, con 57 niñas de bajo nivel socioeconómico (nse) que estaban viviendo en un orfanato.   Método: Las participantes recibieron el programa durante diez semanas consecutivas y se recogieron las medidas previas y posteriores a la prueba. Las medidas evaluaban los síntomas de ansiedad, el nivel de autoconcepto, la esperanza, la capacidad de afrontamiento y las dificultades psicosociales de las participantes. También se evaluó la validez social.   Resultados: Los resultados mostraron cambios positivos, incluyendo una disminución en los síntomas de ansiedad y las dificultades psicosociales, así como un aumento en su capacidad proactiva de afrontamiento. Varias subescalas y elementos de las medidas de resultado para autoconcepto y esperanza también reportaron mejorías estadísticamente significativas.   Conclusiones: Las participantes y los padres/cuidadores informaron que el programa era agradable y útil. Se discuten las implicaciones de los hallazgos y las direcciones para futuras investigaciones.Introdução: as pesquisas têm demonstrado que o número de crianças adolescentes que experimentam dificuldades emocionais como a ansiedade vem aumentando, principalmente para os grupos em situação de risco. Viver num orfanato é considerado um fator de risco de atraso no desenvolvimento social, emocional e comportamental de um indivíduo. Objetivos: o objetivo deste estudo para avaliar a eficácia da versão em espanhol do programa friends, um programa de resiliência baseado na Terapia Cognitivo-comportamental, com 57 meninas de baixo nível socioeconômico que estavam morando num orfanato. Método: as participantes receberam o programa durante dez semanas consecutivas e foram coletadas medidas prévias e posteriores à prova. As medidas avaliavam os sintomas de ansiedade, o nível de autoconceito, a esperança, a capacidade de enfrentamento e as dificuldades psicossociais das participantes. Também foi avaliada a validade social. Resultados: os resultados mostraram mudanças positivas, o que inclui uma diminuição nos sintomas de ansiedade e das dificuldades psicossociais, bem como um aumento em sua capacidade proativa de enfrentamento. Várias subescalas e elementos das medidas de resultado para autoconceito e esperança também relataram melhoras estatisticamente significativas. Conclusões: as participantes e os pais/cuidadores informaram que o programa era agradável e útil. Discutem-se as implicações dos achados e as direções para futuras pesquisas

Evidence-Based Mental Health Programs in Schools: Barriers and Facilitators of Successful Implementation

Although schools can improve children’s access to mental health services, not all school-based providers are able to successfully deliver evidence-based practices. Indeed, even when school clinicians are trained in evidence-based practices (EBP), the training does not necessarily result in the implementation of those practices. This study explores factors that influence implementation of a particular EBP, Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Semi-structured telephone interviews with 35 site administrators and clinicians from across the United States were conducted 6–18 months after receiving CBITS training to discuss implementation experiences. The implementation experiences of participants differed, but all reported similar barriers to implementation. Sites that successfully overcame such barriers differed from their unsuccessful counterparts by having greater organizational structure for delivering school services, a social network of other clinicians implementing CBITS, and administrative support for implementation. This study suggests that EBP implementation can be facilitated by having the necessary support from school leadership and peers

Correlates of comorbid anxiety and externalizing disorders in childhood obsessive compulsive disorder

The present study examines the influence of diagnostic comorbidity on the demographic, psychiatric, and functional status of youth with a primary diagnosis of obsessive compulsive disorder (OCD). Two hundred and fifteen children (ages 5–17) referred to a university-based OCD specialty clinic were compared based on DSM-IV diagnostic profile: OCD without comorbid anxiety or externalizing disorder, OCD plus anxiety disorder, and OCD plus externalizing disorder. No age or gender differences were found across groups. Higher OCD severity was found for the OCD + ANX group, while the OCD + EXT group reported greater functional impairment than the other two groups. Lower family cohesion was reported by the OCD + EXT group compared to the OCD group and the OCD + ANX group reported higher family conflict compared to the OCD + EXT group. The OCD + ANX group had significantly lower rates of tic disorders while rates of depressive disorders did not differ among the three groups. The presence of comorbid anxiety and externalizing psychopathology are associated with greater symptom severity and functional and family impairment and underscores the importance of a better understanding of the relationship of OCD characteristics and associated disorders. Results and clinical implications are further discussed

Prevenção seletiva da ansiedade e promoção da resiliência: resultados de um programa de resiliência e prevenção da ansiedade com meninas em risco

Introduction: Research has shown that the number of children and adolescents experiencing emotional difficulties such as anxiety is escalating, especially for those groups at risk. Living in an orphanage has been considered a risk factor for delays in an individuals’ social, emotional and behavioral development. Objective: The aim of this study was to evaluate the effectiveness of the Spanish version of the FRIENDS program, a CBT-based resilience program, with 57 girls from low socioeconomic status (SES) background that were living in an orphanage. Method: Participants received the program for 10 consecutive weeks, and pre- and post-test measures were collected.  Measures evaluated participants’ anxiety symptoms, level of self-concept, hope, coping skills, and psychosocial difficulties. Social validity was also assessed. Results: Results showed positive changes, including a decrease in anxiety symptoms and psychosocial difficulties, as well as an increase in their proactive coping skills. Several subscales and items of the self-concept and hope outcome measures also reported statistically significant improvements. Conclusions: Participants and parents/caregivers reported that the program was both enjoyable and useful. Implications of the findings and directions for further research are discussed.Introdução: as pesquisas têm demonstrado que o número de crianças adolescentes que experimentam dificuldades emocionais como a ansiedade vem aumentando, principalmente para os grupos em situação de risco. Viver num orfanato é considerado um fator de risco de atraso no desenvolvimento social, emocional e comportamental de um indivíduo. Objetivos: o objetivo deste estudo para avaliar a eficácia da versão em espanhol do programa friends, um programa de resiliência baseado na Terapia Cognitivo-comportamental, com 57 meninas de baixo nível socioeconômico que estavam morando num orfanato. Método: as participantes receberam o programa durante dez semanas consecutivas e foram coletadas medidas prévias e posteriores à prova. As medidas avaliavam os sintomas de ansiedade, o nível de autoconceito, a esperança, a capacidade de enfrentamento e as dificuldades psicossociais das participantes. Também foi avaliada a validade social. Resultados: os resultados mostraram mudanças positivas, o que inclui uma diminuição nos sintomas de ansiedade e das dificuldades psicossociais, bem como um aumento em sua capacidade proativa de enfrentamento. Várias subescalas e elementos das medidas de resultado para autoconceito e esperança também relataram melhoras estatisticamente significativas. Conclusões: as participantes e os pais/cuidadores informaram que o programa era agradável e útil. Discutem-se as implicações dos achados e as direções para futuras pesquisas

Correlates of comorbid anxiety and externalizing disorders in childhood obsessive compulsive disorder

The present study examines the influence of diagnostic comorbidity on the demographic, psychiatric, and functional status of youth with a primary diagnosis of obsessive compulsive disorder (OCD). Two hundred and fifteen children (ages 5–17) referred to a university-based OCD specialty clinic were compared based on DSM-IV diagnostic profile: OCD without comorbid anxiety or externalizing disorder, OCD plus anxiety disorder, and OCD plus externalizing disorder. No age or gender differences were found across groups. Higher OCD severity was found for the OCD + ANX group, while the OCD + EXT group reported greater functional impairment than the other two groups. Lower family cohesion was reported by the OCD + EXT group compared to the OCD group and the OCD + ANX group reported higher family conflict compared to the OCD + EXT group. The OCD + ANX group had significantly lower rates of tic disorders while rates of depressive disorders did not differ among the three groups. The presence of comorbid anxiety and externalizing psychopathology are associated with greater symptom severity and functional and family impairment and underscores the importance of a better understanding of the relationship of OCD characteristics and associated disorders. Results and clinical implications are further discussed