Predictors of the rate and course of reactive attachment disorder and disinhibited social engagement disorder symptoms in foster children during the first year of placement.

BACKGROUND: Due to adverse care experiences, foster children are at risk for developing symptoms of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). OBJECTIVE: This study investigated the factors influencing rate and course of RAD and DSED symptoms during the first year of placement in long-term foster care. PARTICIPANTS AND SETTING: The sample consisted of 55 foster children aged 1 to 6 years. Measurements were taken at placement as well as 6 and 12 months after placement. METHODS: RAD and DSED symptoms were assessed with the Disturbance of Attachment Interview (DAI). DSED symptoms were also assessed by observation with the Rating of Infant Stranger Engagement (RISE). Foster parents and caseworkers reported on children's preplacement experiences and placement characteristics. RESULTS: RAD symptoms were rare at Wave 1 (5.5 %) and remitted in most children within the first six months of placement, t(54) = 3.06, p = .003. A total of 30.9 % of the foster children presented DSED symptoms according to the DAI, but only 5.5 % of the children according to the RISE. Foster parents reported symptom reduction, t(54) = 3.71, p = .003, while observational data indicated symptom stability. Prior placement in emergency foster care was associated with lower levels of RAD at Wave 1, F(1.62, 80.88) = 7.80, p = .002, while later placed children presented more RAD and DSED symptoms (RRAD2 = 0.07, RDSED2 = 0.08, RRISE2 = 0.12). Psychopathology of the biological parents (RRAD2 = 0.07, RDSED2 = 0.08) and visitation with the biological parents (RRISE2 = 0.14) predicted symptom stability. CONCLUSION: A substantial number of foster children present persistent DSED symptoms indicating a need for evidenced based interventions.

Attachment disorder symptoms in foster children: development and associations with attachment security.

BACKGROUND: Children in foster care constitute a risk population for developing symptoms of attachment disorders. However, little is known about the longitudinal course of attachment disorders and their association with attachment security in foster children. METHOD: This longitudinal study assessed attachment disorder symptoms in a sample of foster children (n = 55) aged 12 to 82 months. Foster parents with a newly placed foster child were assessed at three points during the first year of placement. At all assessment points, the Disturbance of Attachment Interview (DAI; Smyke and Zeanah in Disturbances of attachment interview, Tulane University, New Orleans, 1999) and the Attachment Q-sort (AQS; Waters and Deane in Monogr Soc Res Child Dev 50:41-65, 1985 German version as reported (Schölmerich and Leyendecker in Deutsche Übersetzung des attachment behavior Q-Set, revision 3.2. Unpublished manual, Ruhr University Bochum, Bochum, 1999) were used to investigate the interplay between disorder symptoms and attachment security. RESULTS: The results revealed that the symptoms of attachment disorders decreased. The decrease was more pronounced for the inhibited than for the disinhibited symptoms with marked changes in the first 6 months of placement. There was a noticeable gender difference in the development with boys showing a more pronounced decrease in inhibited attachment disorder symptoms and a stronger increase of attachment security. After 12 months, no significant gender effects were found. Regarding the association between symptoms of attachment disorders and attachment security, a significant negative correlation between the inhibited attachment disorder symptoms and attachment security was found 12 months after placement. CONCLUSIONS: Attachment disorder symptoms decreased in the stable foster care environment. Thus, foster care seems to be an effective placement option regarding children's attachment development.

Inhibited symptoms of Attachment Disorder in children from institutional and foster care samples.

The main objective of the article was to study the prevalence of symptoms of the inhibited attachment disorder depending on type and quality of the caregiving environment. Analyses were based on data of a sample of institutionalized children from Georgia (N = 16), and two samples of foster children from Georgia (N = 27) and Germany (N = 55). Inhibited attachment disorder symptoms were assessed by the Disturbances of Attachment Interview (DAI) and the Rating of Inhibited Attachment Behavior (RInAB). Further assessments included behavior problems in children, quality of caregiving behavior in foster parents/caregivers, and presence of preferred caregiver in the institution. Regarding inhibited attachment behavior, expected differences between institutional (high scores) and foster samples (low scores) found for both measures (RInAB and DAI), and convergent validity between these measures was found in the institutional sample, but not in the foster samples. There were also indications of construct validity (regarding preferred caregiver in institution and caregiver supportive presence). The findings also suggest methodological issues brought about by skewed distributions of positive and negative measures in high-risk and low-risk samples, respectively.

Assessment of attachment disorder symptoms in foster children: comparing diagnostic assessment tools.

BACKGROUND: Standardized methods for assessing attachment disorders are scarce but needed for research and practice. METHODS: In the current study, several assessments for attachment disorder symptoms are used within a German sample of foster children after being exposed to neglect and maltreatment in their biological families. The symptoms were assessed with four established assessment methods based on both parents' report and behavioral observation: The Rating for Infant Stranger Engagement, the Stranger at the Door, the Disturbances of Attachment Interview and the Reactive Attachment Disorder Questionnaire. RESULTS: The foster care sample showed symptoms of both the inhibited and the disinhibited attachment disorder. The degree of symptoms is comparable to previous findings. The results of the different tools investigating the disinhibited type of attachment disorder are correlated to each other, but do not overlap. CONCLUSIONS: Although all approaches are based on the clinical criteria of the DSM-IV, the assessments do not coincide. Each tool provides a different point of view on the symptoms, so a multi methodical approach for assessing attachment disorder symptoms should be implemented. Furthermore, the inhibited and the disinhibited symptoms represent separate categories, as reflected in the DSM-5, requiring separate assessment.

Predictors of foster parents' stress and associations to sensitivity in the first year after placement.

In Germany, almost 70 000 children are living in foster families (Statistisches Bundesamt, 2016). Many foster children show mental health problems as they were exposed to an accumulation of risk factors. Hence, foster parents are often faced with challenging parenting situations. The current study focuses on the predictors of foster parents' stress and examines longitudinally whether parenting stress is associated with foster parents' sensitivity. The sample consisted of 55 children (aged from 1 to 6 years) and their foster caregivers. Foster parents' sensitivity was observed during home visits. Caregiver reports were used to assess parenting stress (Parenting Stress Index) as well as foster children's externalizing behavior problems (Child Behavior Checklist). For main caregivers' stress at the beginning of placement, regression analyses revealed both, foster children's externalizing problems as well as partners' stress as predictive. For main caregivers' stress one year after, only initial parenting stress and partners' stress were predictive. Foster parents' sensitivity was correlated with their parenting stress one year after placement. Regression analyses revealed no longitudinal effects of initial parenting stress on overall sensitivity. However, supportive presence was predicted by initial supportive presence and by the interaction between parenting stress and children's externalizing problems at placement. The findings highlight the role of the partner in experiencing parenting stress when taking care of a foster child. Furthermore, they emphasize that foster parents who care for children with behavior problems need adequate support that can buffer initial parenting stress and thereby promote sensitive caregiving.

[The Relationship Between Attachment Representations of Foster Parents and Foster Children and the Role of the Child's Sex]. / Der Zusammenhang von Bindungsrepräsentationen zwischen Pflegeeltern und Pflegekindern unter Berücksichtigung von Geschlechterunterschieden.

Children who have been placed in foster care after having experienced difficult family situations need to experience secure relationships. The development of a secure attachment model is regarded as a key protective factor for a healthy development. The present study examines predictors of attachment representations in a sample of 37 foster children aged three to eight years. Children's attachment representations were assessed using the Attachment Story Completion Task, and foster parents' attachment representations with the Adult Attachment Interview. Female foster children scored higher in secure attachment representations than males. Attachment representations of male foster children were positively influenced by a secure attachment representation of their primary foster parent and slightly by the duration of placement in the foster family as well as their age of placement but differently than expected. These results suggest that male foster children may be more vulnerable in their development of attachment representations and that foster parents' state of mind regarding attachment as well as the duration of the placement seem to have an impact on the development of attachment patterns in their foster children. This should be considered in the choice and counseling of foster parents.

[Accessing Disturbances of Attachment Symptoms Using Interview Technique]. / Interviewtechnik zur Erfassung von Bindungsstörungssymptomen.

Disturbances of attachment represent a clinically significant disorder and seriously impair social behavioural functioning. To date there has been little research and valid diagnostic methods are lacking. In the present study a German Version of the Disturbances of Attachment Interview developed by Smyke and Zeanah (1999) was used to assess disturbances of attachment in a sample of foster children and the validity of the translation is investigated. Furthermore, the Strengths and Difficulties Questionnaire (Goodman, 1997) was used to examine the discriminative validity. The results show a satisfying reliability and the scales of attachment disorders declare the main of the variance. There is a weak association between the disinhibited scale and hyperactivity in the SDQ. Overall the disinhibited disorder can be distinguished from other behaviour patterns. Regarding the inhibited scale there are associations with all SDQ scales and the inhibited category seems harder to distinguish from other deviant developmental issues. The method is evaluated as a qualified approach to the diagnosis of attachment disorders in the context of a multimethodical approach. Furthermore, the findings suggest further examination of the construct of attachment disturbances.