Developmental pathways linking early caregiving intervention to reduced externalizing behaviors in previously-institutionalized youth: findings from the Bucharest Early Intervention Project

• In Event: Biobehavioral Developmental Mechanisms Linking Early Institutional Care to Later Externalizing Psychopathology

Abstract

Introduction: Children raised in institutions face profound psychosocial deprivation, contributing to poor social and emotional developmental outcomes (IJzendoorn et al., 2020). Findings from the Bucharest Early Intervention Project (BEIP) indicate that previously-institutionalized children demonstrate elevated levels of general psychopathology (‘p’ factor) and residual externalizing factor at age 8 compared to a never-institutionalized comparison group (NIG); however, children randomly assigned to be removed from institutions early in life and placed into high-quality family-based care (foster-care-group, FCG) show significant decreases in both ‘p’ and specific externalizing factor scores over adolescence compared to children randomly assigned to remain in in institutional care (care-as-usual group, CAUG; Wade et al., 2019). Self-regulation, the capacity to regulate thoughts, feels, and behaviors, may be a core developmental mechanism linking early psychosocial deprivation to later risk for psychopathology, particularly externalizing difficulties. Preliminary evidence suggests self-regulation may impact later risk for psychopathology through its effects on social relationships (Laceulle et al., 2019). Using BEIP data, we tested the hypothesis that foster-care intervention reduces vulnerability to specific externalizing problems among previously institutionalized youth via growth in self-regulation over adolescence and associated reductions in peer difficulties.

Methods: 220 children (58 CAUG, 62 FCG, 100 NIG) contributed data for analyses. First, growth trajectories for self-regulation from ages 8 to 16 were estimated from Social Skills Rating Scales self-control subscale scores collected longitudinally (SSRS; Gresham & Elliot, 1990), using latent multigroup modeling with Bayesian estimation (Mukerji et al., 2021). Confirmatory factor analysis was used to derive a latent factor reflecting peer difficulties at age 16 from the Macarthur Health & Behavior Questionnaire peer relations subscale (HBQ; Essex et al., 2002). Using latent bifactor modeling, general psychopathology (‘p’ factor) and residual internalizing and externalizing factors were derived from the HBQ mental health subscales at age 16 (Wade et al., 2018). To specifically examine the effects of foster-care intervention on externalizing problems among previously-institutionalized children via growth in self-regulation and peer difficulties, we tested a serial mediation model (FCG vs CAUG → change in self-regulation over adolescence → peer difficulties → specific externalizing problems).

Results: The total effect (c) of foster care intervention on residual externalizing factor at age 16 was not significant (b=-0.32, t=-1.51, p=.14), nor was the direct effect (c’), controlling for effects of mediators (b=-0.09, t=-0.45, p=.65). Only one indirect path was significant: the specific indirect effect of foster-care intervention on residual externalizing factor scores through growth in self-regulation (point estimate: -0.22; 95% CI [-0.498, -0.043]).

Discussion: Foster care intervention contributed to increased self-regulatory growth over the course of adolescence, which was then associated with reduced specific externalizing problems at age 16, controlling for general psychopathology. The effects of growth in self-regulation on specific externalizing symptoms were not further mediated by peer difficulties. These results suggest that self-regulatory growth over adolescence is a developmental mechanism through which early caregiving intervention reduces specific externalizing problems among previously-institutionalized youth. Scaffolding growth in self-regulation during adolescence may be a promising target for interventions to reduce long-term effects of institutionalization on externalizing behaviors.

Authors

• Cora E Mukerji, Bryn Mawr College
  Presenting Author

• Mark Wade, University of Toronto

• Nathan A Fox, University of Maryland - College Park

• Charles H Zeanah, Tulane University

• Charles A. Nelson, Harvard Medical School