[Early intervention and psycho-educational support: a review of the English language literature]. / Soins médicosociaux précoces et accompagnement psychoéducatif: revue de la littérature étrangère.

While research on early-intervention programs remains rare in France, there are numerous scientific publications in the English-language literature. This article attempts to describe the contribution of such programs in terms of children subsequent development and changes in their families. Twenty-six programs incorporating home intervention, care, social support and early-childhood education, have been conducted for more than a year within local and hospital populations selected through various scales of risk. The large majority of the programs have randomized trials. Intervention and early education applied essentially to families from deprived environment, families with premature or low-birth-weight infants, and families exhibiting psychosocial or psychiatric risks. Programs of relatively long-term and addressing to families' needs and well-being, initiated in the prenatal period, resulted in variable degrees of positive influences on children cognitive, behavioural and social development, and on parent-child relationships. The most remarkable results with the most prolonged effects concerned school attendance and school performance. Positive effects were also recorded in specific populations (adolescent mothers, mentally retarded mothers.). Nevertheless the efficacy of such programs remained limited and mainly dependent upon parents' motivation and involvement and concurrent family risk factors. Although evaluation of intervention programs regarding multiple risk factors remains difficult, qualitative analyses complementing the available statistical data appear necessary.

How can we boost IQs of "dull children"?: A late adoption study.

From 5,003 files of adopted children, 65 deprived children, defined as abused and/or neglected during infancy, were strictly selected with particular reference to two criteria: (i) They were adopted between 4 and 6 years of age, and (ii) they had an IQ <86 (mean = 77, SD = 6.3) before adoption. The average IQs of adopted children in lower and higher socioeconomic status (SES) families were 85 (SD = 17) and 98 (SD = 14.6), respectively, at adolescence (mean age = 13.5 years). The results show (i) a significant gain in IQ dependent on the SES of the adoptive families (mean = 7.7 and mean = 19.5 IQ points in low and high SES, respectively), (ii) IQs after adoption are significantly correlated with IQs before adoption, and (iii) during adolescence, verbal IQs are significantly lower than performance IQs.

Adoption and fostering of babies with Down syndrome: a cohort of 593 cases.

Recently, professionals in France have noticed an increase in newborns with Down syndrome (DS) being placed for adoption. The aim of this study was to investigate DS babies given up at birth for adoption and to consider the possible determinants of this in order to assess social acceptance of DS. A retrospective cohort of all living DS babies was collected from two birth-defect registries (Paris: 1981-1990; Marseilles area: 1984-1990). Follow-up data were collected: characteristics of the baby, biological parents and maternity units, age when given up for adoption, and type of foster care. The results showed that 19.4 per cent of infants with DS (115/593) were rejected by their parents. Multiple regression analysis indicated that foreign origin of the mother, area of residence, no associated major malformation, maternal age (15-24 years), and birth rank (> 2) variables were significantly associated with a lower placement rate. Among the 115 abandoned infants with DS, 88 came from unknown parentage (76.5 per cent). For half of them, adoptive placement (88/115) occurred before the age of 6 months. Socio-cultural attitudes play a great part in these family decisions. Equally important is the manner in which professionals propose adoption as an alternative to these parents of DS babies. They should be encouraged to consider all options before making a decision, so that the best solution can be found for the interest of all.

Adult outcome of children reared for long-term periods in foster families.

OBJECTIVE: To study the long term impact of adverse childhood experiences resulting from family breakdowns combined with a stable care environment. Another aim was to determine predictive factors for maladjusted psycho-social integration in adulthood. METHOD: Sixty-three children from severely psychosocially dysfunctioning families selected from among those having been in care in an institutional setting: All had been reared for at least 5 years by foster families, had been out of care for more than 5 years and were at least 23 years old at the time of the survey. Semi-structured interviews were used in a follow-up study to assess adult outcome, essentially in terms of professional status, social, and family relationships. RESULTS: Data was obtained for 94% of the study population (n = 59), 71% via direct interviews (n = 45). The majority had managed to overcome their childhood adversities: 56% were well-integrated socially, 12% had average integration results, 20% were partially integrated and 10% were in situations of failure. These difficulties were linked to multiple family disturbances and repeated traumatic experiences during childhood (p < .05). Multiple regression analyses indicated that these risk factors accounted for 28% of the variance in the social integration score (p < .0001). Severe emotional deprivation over a prolonged period was a contributing factor to clinical disorders. CONCLUSION: At the study period, intergenerational repetition of "child placement" behaviors, significant in the previous generation, had practically disappeared. The results also highlighted the substantial psychotherapeutic and child-rearing assistance provided by the staff of the foster care agency.

[Announcing the trisomy 21 diagnosis and care of the infant in the maternity ward: counseling offered to the parents]. / Annonce de la trisomie 21 et accueil de l'enfant en maternité: les propositions faites aux parents.

Which solutions to child care are proposed to parents just after the diagnosis of Down's syndrome? The situation of Down's syndrome babies born in 1980-89 and abandoned at birth in Paris was studied. Semi-structured interviews were conducted with medical and social staffs of 13 maternity hospitals where 60% of these DS babies were abandoned. In 10 years, 102 DS babies were given up to the Child Welfare Agency and to private adoption agencies. They represent 10% of all abandoned children at birth and 22% of DS live births in Paris. Relations between abandonment, type of maternity hospital and social class of parents are analysed. Several factors influence the parents' decision in planning for the child: handicap, advice and way of presenting alternatives: in 1/3 of the cases, adoption was proposed directly. In the great majority, the child abandonment was decided in a situation of emergency and profound emotional stress, and outside of the legal procedure. Health care workers should listen to parents more so they can be better informed about their child's prognosis and all care alternatives before making their decision.

[Trisomy 21 and abandonment. Infants born and placed for adoption in Paris]. / Trisomie 21 et abandon. Enfants nés et remis en vue d'adoption à Paris.

BACKGROUND: Most handicapped newborns that are abandoned suffer from Down's syndrome. This report describes the frequency of the practice. POPULATION AND METHODS: All children (95% less than 1 month old) born between 1985 and 1987 in Paris who were placed for adoption by approved agencies were included in this study. Sociofamilial, medical and psychological histories were collected. RESULTS: A total of 326 infants were abandoned during these 3 years. 38 (12%) of them had Down's syndrome. 25 of the 34 mothers were 30 years old or more. 23 of 27 infants had two known parents. 134 newborns with Down's syndrome were registered in Paris during this period. Thus 27.6% of the total number of Down's syndrome children were abandoned. 87.2% of the abandoned non-trisomic infants were adopted, versus 31.6% of those with Down's syndrome (10.5% died before adoption). The 19 children with Down's syndrome who were not adopted live in foster families. CONCLUSION: 2/3 of the mothers who have abandoned their trisomic infant were less than 35 years old and had a middle-class background. Further studies are necessary to better understand the emotional context of abandonment.