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.

The Effectiveness of Psychological Interventions on the Impact of Trauma Exposure in Foster Care: A Meta-Analysis.

Due to prevalent exposure to trauma in the biological family, children in foster care often experience post-traumatic stress symptoms, difficulties in forming secure attachments with the caregivers, and can present a complex range of symptoms and impairments across several areas of development. Therefore, there is an increased necessity for interventions on the effects of trauma exposure in foster care. This is the first meta-analysis to investigate the effectiveness of interventions on the effects of trauma exposure in foster care against control groups. Twelve randomized controlled trials on interventions for children with trauma-related diagnoses or with other mental health problems that are a result of complex trauma were included. A random-effects model was used for pooling the effect sizes, which were calculated for trauma-related outcomes at posttreatment and follow-up. Several potential moderator variables were analyzed. The results showed that participants receiving the intervention on trauma-related problems reported significantly better outcomes than those in the control conditions at posttreatment, after the exclusion of one outlier (g = 0.39; 95% CI [0.18 to 0.62]). The effect size was smaller at follow-up (g = 0.24; 95% CI [0.03 to 0.46]), but significant. Clinical diversity, methodological diversity, as well as other limitations were identified and discussed. Overall, the findings highlight the potential of interventions for trauma-related problems in foster care. These findings bring important contributions to the child welfare system in their efforts to develop and adapt suitable interventions for children with mental health problems due to trauma. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-023-00563-9.

Measurement Models of Child Maltreatment and Associations With Suicidal Ideation Endorsement by Youth in Foster Care: A Multiverse Analytic Approach.

Youth suicidal ideation is a prevalent experience, particularly among youth exposed to maltreatment, with a variety of indicators such as youth statements of ideation. To better understand suicidal ideation, and the associations with youth mental health outcomes, a fruitful path may be through the study of the dimensions (e.g., severity, frequency) of maltreatment exposure. While there exists extensive work on methods to best operationalize casefile records of maltreatment, such work has not been undertaken for youth self-reports, which are an important indicator of youth functioning following exposure. To address the lack of clarity of how to best operationalize youth self-reports of maltreatment, a multiverse analytic approach was taken to operationalize severity and frequency in a sample of 471 8- to 17-year-old children in foster care. We examined differences across measurement models and the models' associations with caregiver reports of youth suicidal ideation statements. Results indicate that the operationalizations used to define maltreatment resulted in differing measurement models that further differed in their associations with reports of youth suicidal ideation. This study highlights the importance of how researchers operationalize their data and the role dimensions of maltreatment have in further elucidating differential outcomes for youth exposed to maltreatment.

A qualitative exploration of the drivers for the transfer of foster children in Gauteng, South Africa.

BACKGROUND: Many children in South Africa are orphaned or subjected to maltreatment, leaving them in need of care and protection. Foster care is one form of alternative care for such children. Retention of foster parents, or foster care placement stability, is one of the many challenges related to foster care, globally and in South Africa. This instability can have an adverse impact on children, and although some research speaks to the problem, the experiences of South African role players regarding this problem have not been documented, to date. To improve foster care retention in South Africa, local, contextualized studies exploring the drivers of foster care placement instability are required. AIM: The aim of this qualitative study was thus to explore designated social workers' (DSWs) and foster parents' experiences about the reasons prompting foster care transfers. PARTICIPANTS AND SETTING: A purposively selected sample of ten foster parents and ten DSWs in the Gauteng province of South Africa took part in the study. METHODS: A descriptive qualitative study was adopted as basis for this study, which entailed thematic analysis of 20 semi-structured interviews. RESULTS: It was found that children's behavioural problems, a shortage of resources, a lack of parenting skills, problematic relationships between foster parents and foster children, and previous traumatic events, led to most foster care transfers. A key finding from this study, which appears not to be evident in previous studies, centres on the critical role played by money, or rather its absence, in contributing to foster care placement instability. CONCLUSIONS: When considered in conjunction with findings emerging from previous studies, our findings underscore the importance of obtaining a contextualized understanding of local, cultural factors at play in foster care delivery. To improve foster care retention in South Africa, which is fraught with challenges not yet reported elsewhere, it is recommended that screening procedures for foster parents be revised, and that allocation of resources to DSWs be prioritized.

'Well, the Child Can't Choose, Right?': Foster Children's Participation Experiences of Child Protection Removal Practices.

According to the United Nations Convention on the Rights of the Child, children have the right to voice their opinions and participate in decision-making in matters affecting their lives. Furthermore, professionals working with children have the responsibility to always make the best interests of the child the priority when contemplating decisions that have an impact on the child, including by ensuring that the child's concerns are paid attention to and their opinion is taken into consideration. However, studies indicate that the opposite occurs in practice and that decision-making in child protection cases often excludes children's views, especially in alternative care. In this qualitative study, 31 foster children's perspectives were gathered through in-depth semi-structured and focus group interviews with the aim of exploring the children's participation and perspectives based on their lived experiences within the context of child protection removal practice in Estonia. Findings indicate several obstacles that hinder children's meaningful participation, including not receiving adequate or truthful information about their removal and placement. Furthermore, they had no trustworthy adult to talk to and, therefore, they lacked opportunities to discuss their views or concerns with someone capable of acting on them. These findings suggest that children's active and meaningful participation in alternative care requires more attention and implications in practice.

Preventing Revictimization Through a Web-Based Intervention for Primary Caregivers of Youth in Care (EMPOWERYOU): Protocol for a Randomized Factorial Trial.

BACKGROUND: Children in foster care are at a higher risk for relationship problems than their counterparts raised by their biological family because of higher exposure to or prevalence of neglect or maltreatment early in life. Consequently, these children may also show more challenging behavior in their foster families, which in turn increases the parental stress experience of foster caregivers. Furthermore, the children may engage in a vicious cycle of risky relationship behaviors and expectations that put them at a greater risk for revictimization. OBJECTIVE: To support foster caregivers in reducing the risk for revictimization, several intervention modules delivered via the internet were developed using a consumer-based approach (phase 1 of the multiphase optimization strategy). This project (phase 2 of the multiphase optimization strategy) aimed to develop a sustainable intervention by selecting promising intervention components based on their contribution to the outcome. METHODS: In a 24 factorial trial, a total of 317 foster caregivers with children aged 8 to 13 years are randomly assigned to 1 of 16 conditions. The primary outcome is the rate of revictimization from baseline to 3 months after intervention. Secondary outcomes include risk-taking and functional behaviors in relationships. All caregivers will receive access to all the intervention components after the follow-up assessment. The participants assigned to the condition with all component levels on are expected to show the best improvement in the primary and secondary outcomes. RESULTS: Recruitment and data collection for the factorial trial started in March 2022 and is ongoing. As of October 2022, we recruited 181 families. Although it is difficult to predict the exact study timeline owing to COVID-19 pandemic-related delays, results are expected in February 2024. CONCLUSIONS: There is a need for easily accessible information related to raising children in foster care who have experienced early life adversities to interrupt the cycle of violence and enhance the developmental pathway of health and emotional stability. It might be useful, in addition to generally useful parenting information (eg, parental self-care or emotion regulation management), to specifically focus on the needs of these caregivers (eg, how to support the child to reduce dysfunctional relationship behaviors that may have developed because of early adverse experiences). TRIAL REGISTRATION: ClinicalTrials.gov NCT05235659; https://clinicaltrials.gov/ct2/show/NCT05235659. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38183.

An updated examination of the predictors of running away from foster care in the United States and trends over ten years (2010-2019).

BACKGROUND: Among the more than 400,000 children in foster care, there is a small group who will run away from care and face increased risks of negative outcomes. Previous studies on the predictors of running away from care use limited samples or outdated data. OBJECTIVE: The present study replicates and extends prior research by presenting an updated analysis of predictors of running away from foster care as well as 10-year trends in the prevalence and predictors of running from care. PARTICIPANTS AND SETTING: This study uses the Adoption and Foster Care Analysis and Reporting System (AFCARS) data to assess the runaway status of 597,911 children who were involved in foster care in 2019. Longitudinal trend analyses utilize AFCARS data from 2010 to 2019. METHOD: Using chi-square/t-tests and binary logistic regression analyses, this study investigates individual- and case-level predictors of running away from foster care programs. RESULTS: Findings show that girls (OR = 1.29, p < .001), African American children (OR = 1.89, p < .001), and older children (OR = 1.61, p < .001) are at increased risk of running away from foster care. Removal reasons such as child substance abuse (OR = 1.65, p < .001), abandonment (OR = 1.38, p < .001), and child behavioral problems (OR = 1.31, p < .001) are also associated with an increased risk. Analysis of 10-year trends shows a steady decline in running from care: 1.40% in 2010 to 0.98% in 2019. The profile of risk factors is stable overall, with a few notable exceptions. CONCLUSIONS: The percent of children running from foster care is at a 10-year low. Prevention and intervention efforts regarding running from care must focus on the needs of African American and Hispanic children, especially girls, as well as children with substance use or behavior problems. Given that programs rarely have prospective information regarding why children leave care and the negative consequences of labeling children as "runaways," shifting language to "missing from care" should be considered.

Psychosocial well-being of Flemish foster children residing in their foster homes during the COVID-19 lockdown.

The measures implemented to contain the COVID-19 pandemic profoundly affected the lives of children and families all around the world, probably affecting children's psychosocial well-being. The negative consequences of lockdowns are presumed to hit even harder on vulnerable groups such as foster children who already struggle with their psychosocial well-being in normal circumstances and who face specific challenges during lockdowns such as: additional help that is no longer available or only offered digitally and physical contact with birth parents that is forbidden. Nevertheless, some scholars point to the positive side of lockdowns (e.g.: relief due to closure of schools). This study aims to asses the psychosocial well-being of Flemish foster children residing in their foster homes during the COVID-19 lockdown and the factors that are associated with the change in their psychosocial well-being. 888 foster parents reported on the psychosocial well-being of just as many foster children through the Brief Assessment Checklist for Children and Adolescents. The COVID-19 lockdown was not associated with a decreased psychosocial well-being of Flemish foster children residing in their foster homes during the lockdown. Foster parents reported a slight improvement in their relationship with their foster child during the lockdown which points to a positive consequence of the lockdown. In addition, this improvement was positively associated with an increased psychosocial well-being during adverse circumstances and should therefore be enhanced. The type and amount of contact with birth parents is significantly associated with foster children's changed psychosocial well-being during the lockdown. Foster parents who reported an increase in alternative contact (e.g., (video)calls and messages) between their foster child and his/her birth parent(s) during the lockdown, also reported an increase in their foster child's psychosocial well-being during that period.

What Proportion of Foster Care Children Do Not Have Child Protective Services Reports? A Preliminary Look.

It is perhaps surprising that we lack complete national information about why children enter foster care. While the annual Adoption and Foster Care Analysis Reporting System (AFCARS) report is informative, it leaves many questions unanswered, particularly "how many children enter foster care by means other than Child Protective Services (CPS) reports?" Drawing from a unique new integrated dataset, we examined foster care data (AFCARS) and CPS report data (National Child Abuse and Neglect Data System Child File). The linked dataset included 210,062 children with foster care placements in 2017 and no placements in the prior 5 years. We categorized each placed child along two dimensions of four levels each: Time since prior CPS report (if any) and stated AFCARS placement reason, ranging from clearly maltreated to clearly not maltreated. We also tracked the siblings of placed children, to see if non-maltreated children entered care because of maltreated siblings. We find that between 8-35% of children enter foster care for reasons other than maltreatment, depending how thresholds are set. These numbers decline somewhat when siblings are considered. A meaningfully large number of children are placed in foster care for reasons other than maltreatment investigated by CPS. Further research into these children is warranted to better inform foster care policy.

A Systematic Review on Foster Parents' Psychological Adjustment and Parenting Style-An Evaluation of Foster Parents and Foster Children Variables.

The current systematic review aimed to evaluate the variables influencing foster parents' parenting stress, distress and parenting style, thereby supporting their adjustment and well-being as well as that of foster children. A PRISMA-guided search was conducted in three databases. Observational studies examining parenting stress, parenting distress (subsuming anxiety, depression and stress symptoms) and parenting style-all assessed through validated tools-were considered. A total of 16 studies were included, comprising N = 1794 non-relative foster parents (age range = 30-67 years). Results showed heightened parenting stress over time, both overall and compared to parents at large. Neither foster parents' nor foster children's socio-demographic characteristics significantly contributed to the increase in parenting stress; yet child-related stress and children's externalizing problems were its main predictors. Foster parents' couple cooperation was associated with reduced parenting stress. Moreover, the authoritative parenting style was associated with parental warmth, while the authoritarian style was associated with foster parents' greater perceived burden, greater criticism and rejection toward the foster child. Evidence supports the mutual influence between foster parents and children. Foster care services should support foster parents' needs within a concentric modular system, to ultimately provide better care for both foster parents and children.

Identifying treatment moderators of a trauma-informed parenting intervention with children in foster care: Using model-based recursive partitioning.

BACKGROUND: Trauma-informed parenting interventions have been used in child welfare to help caregivers respond to children in trauma-informed ways that can mitigate the effects of maltreatment and build strong caregiver-child relationships. Existing studies support their effectiveness with children and youth involved in the child welfare system. However, to further advance the effectiveness of evidenced-based intervention for child welfare populations, one key step is to identify subgroups of individuals who have different intervention responses or outcomes. OBJECTIVE: To identify pre-treatment moderators that can distinguish subgroups of caregivers and children who benefit differently from an intervention. PARTICIPANTS AND SETTING: 414 children in foster care (age 3 or younger) and their caregivers (birth, adoptive, kin, and nonkin) were randomly assigned to receive a trauma-informed parenting intervention in the Illinois Birth through Three Title IV-E waiver demonstration or foster care services as usual. METHODS: Model-based Recursive Partitioning (MOB) was used to identify treatment moderators and moderator interactions. MOB fits a parametric model and uses a data-driven method to find subgroups for which the specified parametric model has different parameters. Two parametric models (logistic and linear regression) were used in accordance with two outcomes: reunification (binary) and caregiver-child attachment (continuous). We examined 21 potential pre-treatment moderators in both models. RESULTS: For the reunification outcome, the MOB produced the following three treatment moderators, which identified subgroups of participants who responded differently to the intervention: (a) caregivers' relationship with the child (kin vs. non-kin/permanent caregivers), (b) caregiver-child attachment, and (c) case history of physical abuse. For the attachment outcome, caregivers' age was found to be a treatment moderator. Future developments of trauma-informed interventions should consider these moderators.

A Life Course Study on Traumatic Brain Injury and Physical and Emotional Trauma in Foster Children.

Foster children are exposed to high levels of abuse, violence, and other adverse events throughout their childhood and adolescent years. Forms of brain injury, notably traumatic brain injury (TBI), are understudied in the foster child population. This study aimed to explore different forms of brain injury and their cognitive, behavioral, and psychological/emotional effects on current and former foster children using a life course perspective. A thematic analysis with a life course perspective was used to examine semi-structured, open-ended interviews conducted with current and previous foster children between the ages of 16 and 29 years. The study included 47 participants: 25 males (53%) and 22 females (47%) with an average age of 21 years and an average of 11.2 years of education. Of 47 current and previous foster children between the ages of 16 and 29, two-thirds had sustained one or more TBIs. Through a thematic analysis, four overarching and inter-related themes emerged from the data: frequent TBI, normalization (of abuse, violence, injury, and neglect), emotional trauma, and dangerous coping methods such as alcohol use in 94% and recreational drug use in 81%. Normalization of adverse events, emotional trauma, and the use of dangerous coping methods occurred in 66%, 81%, and 49% of participants, respectively, and are the cumulative toxic long-term effects of early negative life experiences and repeated forms of brain injury. Early and continued exposure to TBI, abuse, violence, and/or neglect with continued maladaptive behaviors suggests that the participants may have experienced changes in brain structure and function over their lives that provided the milieu for continued vulnerability to personal and future injury to future generations. These behavioral and perceptual changes point to a toxic combination of injuries that result in continued vulnerability to repeated injury through contextual exposure to risks and maladaptive normalization, emotional trauma, and risky coping styles.

Foster Parents' Parenting and the Social-Emotional Development and Adaptive Functioning of Children in Foster Care: A PRISMA-Guided Literature Review and Meta-Analysis.

Children in foster care (CFC) are at increased risk for negative developmental outcomes. Given the potential influence of foster parents' parenting on the development of CFC, this literature review and meta-analysis provide an initial overview of how parenting factors in foster families relate to CFC's developmental outcomes. We aimed to explore (1) whether foster parents' parenting conceptualizations are related differently to various CFC developmental outcome variables and (2) how characteristics of foster parents and CFC moderate these associations. Following the recommendations of the PRISMA statement, we searched four databases in 2017 (with an update in May 2020). Forty-three primary studies were coded manually. The interrater agreement was 92.1%. Parenting variables were specified as parenting behavior, style, and goals and were distinguished further into functional and dysfunctional parenting. CFC development was divided into adaptive (including cognitive) development and maladaptive development. Meta-analyses could be performed for foster parenting behavior and developmental outcomes, as well as for functional parenting goals and maladaptive socioemotional outcomes in CFC. Associations between functional parenting behavior and adaptive child development were positive and negative for maladaptive child development, respectively. For dysfunctional, parenting effects were in the opposite direction. All effects were small to moderate. Similar results were found descriptively in the associations of parenting style and child developmental outcomes. We found similar effect sizes and directions of the associations between parenting behavior in foster families and the child's developmental outcomes as those previously reported for biological families. These findings provide strong support for the significant role of parenting in foster families regarding children's development in foster care.

Foster children's complex psychopathology in the context of cumulative childhood trauma: The interplay of ICD-11 complex PTSD, dissociation, depression, and emotion regulation.

BACKGROUND: Foster children experience maltreatment at exceptionally high rates with increased risk to develop ICD-11 complex posttraumatic stress disorder (CPTSD). While rates of comorbidity between CPTSD and various disorders are high, the interplay between constituent aspects of psychopathology is not clearly understood. No study used network analysis to model the interplay between these aspects as potentially maintaining a stable condition of psychopathology, and research on the etiology and maintenance of CPTSD in children is especially scarce. METHODS: Altogether, 208 Austrian foster children completed a set of standardized measures, resulting in a final sample of N = 122 foster children meeting the inclusion criteria. Experiences of childhood trauma, ICD-11 CPTSD, depression, dissociation, adaptive, and maladaptive emotion regulation were assessed. Following an exploratory approach, analyses were conducted using latent single indicator factor scores in two network models. RESULTS: Domains of CPTSD, PTSD and disturbances in self-organization (DSO), evidenced as most central factors in children's complex psychopathology. Including cumulative childhood trauma did not influence the connectedness of factors in any relevant way. Shortest direct paths from cumulative childhood trauma to CPTSD included dissociation (PTSD) and adaptive emotion regulation (DSO) as mediating factors. LIMITATIONS: Results are based on a small sample of highly-traumatized foster children, potentially limiting current findings' generalizability. CONCLUSIONS: CPTSD identified as central in children's complex psychopathology, while the role of childhood trauma seems stronger for the onset than the maintenance of such psychopathology. The current network revealed central disorders and distinct mediating factors as important targets for treatment strategies and future research.

Symptom structure of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) in trauma-exposed foster children: examining the International Trauma Questionnaire - Child and Adolescent Version (ITQ-CA).

Background: The 11th edition of the International Classification of Diseases (ICD-11) introduces Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) as two distinct trauma-related disorders. Numerous studies support the proposed symptom structure of ICD-11 CPTSD in adults, but only a few studies have examined CPTSD symptom structure in children, reporting diverging results. To assess ICD-11 CPTSD in children, the International Trauma Questionnaire (ITQ) was recently adapted for children and adolescents (ITQ-CA), with no validated German version available yet. Objective: This study aimed (1) to test the symptom structure of ICD-11 CPTSD in a sample of trauma-exposed foster children using the ITQ-CA, and (2) to examine the concurrent, convergent and discriminant validity of the German ITQ-CA. Method: Altogether, 161 Austrian foster children completed a set of standardized measures, resulting in a final sample of 135 trauma-exposed foster children meeting the inclusion criteria. Psychometric properties of the ITQ-CA were assessed using confirmatory factor analysis (CFA), bivariate correlations and multivariate regression. Results: CFA supported ICD-11 CPTSD symptom structure in children as a two-factor higher-order model with PTSD and Disturbances in Self-Organization (DSO) as correlated factors with very good model fit, while a one-factor higher-order model also fitted the data very well. High factor loadings and excellent levels of internal reliability evidenced the psychometric adequacy of the ITQ-CA. Concurrent and convergent validity were evidenced by high correlations between ITQ-CA scales and criterion variables (PTSD symptoms, depression, anxiety, dissociation, lifetime traumatization). Discriminant validity was partly supported by PTSD and DSO being differently predicted by exogenous criterion variables. Conclusions: CPTSD symptom structure in children is in support of the ICD-11 conceptualization. The reliability and validity of the German ITQ-CA are evidenced for the first time, identifying it as an easy-to-use screening instrument to assess ICD-11 PTSD and CPTSD in children. Further implications and areas for upcoming studies are discussed.

Antecedentes: La CIE-11 recientemente publicada presenta el trastorno de estrés postraumático (TEPT) y el trastorno de estrés postraumático complejo (TEPT-C) como dos trastornos distintos relacionados con trauma. Numerosos estudios apoyaron la estructura de síntomas propuesta de TEPT-C en adultos de la CIE-11, pero solo unos pocos estudios examinaron la estructura de síntomas de TEPT-C en niños, reportando resultados divergentes. Para evaluar TEPT-C en niños según la CIE-11, el Cuestionario Internacional de Trauma (ITQ) fue adaptado recientemente para niños y adolescentes (ITQ-CA), sin una versión alemana validada disponible todavía.Objetivo: El estudio actual se estableció para (1) probar la estructura de síntomas de TEPT-C según la CIE-11 en una muestra de niños de crianza temporal expuestos a traumas utilizando el ITQ-CA y para (2) examinar la validez concurrente, convergente y discriminante de la versión en alemán del ITQ-CA.Método: Ciento sesenta y un niños de crianza temporal austriacos completaron un conjunto de medidas estandarizadas, lo que resultó en una muestra final de 135 niños de crianza temporal expuestos a traumas que cumplieron con los criterios de inclusión. Las propiedades psicométricas del ITQ-CA se evaluaron mediante análisis factorial confirmatorio (AFC), correlaciones bivariadas y regresión de objetivos multivariados.Resultados: AFC respaldó la estructura de síntomas de TEPT-C según CIE-11 en niños como modelo de dos factores de orden superior con TEPT y DSO (Perturbaciones en la organización del sí mismo) como factores correlacionados con muy buen ajuste del modelo, mientras que un modelo de un factor de orden superior también se ajustó muy bien a los datos. Las altas cargas factoriales y los excelentes niveles de confiabilidad interna evidenciaron la adecuación psicométrica del ITQ-CA. La validez concurrente y convergente se evidenció por las altas correlaciones entre las escalas ITQ-CA y las variables de criterio (síntomas de TEPT, depresión, ansiedad, disociación, traumatismo de por vida). La validez discriminante fue apoyada en parte por el TEPT y DSO siendo diferenciadamente predicho por variables de criterio exógenas.Conclusiones: La estructura de los síntomas del TEPT-C en los niños respalda la conceptualización de la CIE-11. La confiabilidad y validez de la ITQ-CA alemana se evidencia por primera vez, identificándola como un instrumento de cribado fácil de usar para evaluar el TEPT y TEPT-C de la CIE-11 en niños. Se discuten más implicaciones y áreas para futuros estudios.

Comparing rates of ICD-11 and DSM-5 Posttraumatic Stress Disorder in Austrian children and adolescents in foster care: prevalence, comorbidity and predictors.

BACKGROUND: The diagnostic criteria for Posttraumatic Stress Disorder (PTSD) differ between the DSM-5 and the ICD-11, affecting prevalence and associated metrics of PTSD. OBJECTIVE: Investigating the effects of the diverging DSM-5 and ICD-11 PTSD conceptualizations on prevalence and comorbidity rates, as well as predictor impact in a sample of foster children and adolescents using manual-specific measures. METHOD: The sample consisted of n = 145 foster children and adolescents. PTSD rates were assessed and compared utilizing the International Trauma Questionnaire - Child and Adolescent Version (ICD-11) and the Child and Adolescent Trauma Screen (DSM-5). PTSD comorbidities with Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD) were assessed. The predictive value of age, gender and cumulative trauma for PTSD was determined. RESULTS: A non-significant trend for higher DSM-5 (21.4%) vs. ICD-11 (16.7%) PTSD prevalence was observed. Significantly elevated DSM-5 vs. ICD-11 diagnostic rates were recorded in the re-experience (diff. = 18.3%) and hyperarousal (diff. = 10.1%) clusters. DSM-5 PTSD showed a non-significant trend for higher comorbidities with GAD and MDD. Gender and cumulative trauma predicted PTSD significantly and approximately equally according to both taxonomies. CONCLUSION: The study supports the assumption that utilizing manual-specific PTSD measures in children and adolescents leads to higher rates of DSM-5 PTSD compared to ICD-11 PTSD. The exact methodological reasons for diverging diagnostic rates need to be analysed.

Antecedentes: Los criterios de diagnóstico para el trastorno de estrés postraumático (TEPT) difieren entre el DSM-5 y el CIE-11, lo cual afecta la prevalencia y las métricas asociadas al TEPT.Objetivo: Investigar los efectos de las conceptualizaciones divergentes del TEPT entre el DSM-5 y el CIE-11, utilizando medidas específicas del manual, en las tasas de prevalencia y comorbilidad, así como el impacto predictor en una muestra de niños y adolescentes en condición de acogida familiar temporal.Método: La muestra consistió en un n = 145 niños y adolescentes en condición de acogida familiar temporal. Las tasas de TEPT se evaluaron y compararon utilizando el Cuestionario Internacional de Trauma - Versión para Niños y Adolescentes (CIE-11) y la Prueba de Detección del Trauma para Niños y Adolescentes (DSM-5). Se evaluaron las comorbilidades del TEPT, trastorno de ansiedad generalizada (TAG) y trastorno depresivo mayor (TDM). Se determinó el valor predictivo para TEPT de las variables edad, género y trauma acumulativo.Resultados: Se observó una tendencia, no-significativa, de una mayor prevalencia de TEPT para el DSM-5 (21.4%) comparado con el CIE-11 (16.7%). Se registraron tasas de diagnóstico significativamente elevadas en los grupos de re-experimentación (dif. = 18.3%) e hiperactivación (dif. = 10.1%) para el DSM-5 versus el CIE-11. El TEPT en el DSM-5 mostró una tendencia mayor, no-significativa, para las comorbilidades TAG y TDM. El género y el trauma acumulativo predijeron el TEPT de manera significativa, y aproximadamente equivalente en ambas taxonomías.Conclusión: El estudio apoya el supuesto de que la utilización de medidas TEPT específicas para el manual en niños y adolescentes conlleva tasas más altas de TEPT para el DSM-5 en comparación con el CIE-11. Es necesario analizar las razones metodológicas precisas para estas tasas de diagnóstico divergentes.

Perspective matters: Differences between child- and caregiver-reports of emotion regulation mediating the relationship between cumulative childhood trauma and mental health problems in foster children.

BACKGROUND: Cumulative childhood trauma predicts mental health problems in children, mediated by emotion regulation (ER). To assess trauma history and mental health in children, different informants may be addressed, assessing data from different perspectives. Despite differences between child- and caregiver-reports as robust finding in child psychology, it remains unclear to which extent perspective matters when examining these variables and related associations. OBJECTIVE: The current study was set to (1) examine whether ER mediates the relationship between cumulative childhood trauma and mental health problems in children, (2) test whether results differ with examined perspective, and (3) investigate if meaningful patterns of child-caregiver-reported discrepancies can be identified. METHODS: Data were collected from 145 children living in foster care by child- and caregiver-reports using standardized measures to assess trauma history (CTQ), ER (FEEL-KJ), and mental health problems (CBCL). Mediation and latent profile analysis were calculated. RESULTS: Mediation analysis identified ER as mediator for internalizing and externalizing mental health problems. Using data from different perspectives, mediation models differed considerably regarding significance, direction, and magnitude of effects. Using latent profile analysis, meaningful patterns of child-caregiver-reported discrepancies were identified and associated with children's sociodemographic and psychopathological characteristics. CONCLUSIONS: Adaptive and maladaptive ER distinctively mediate the relationship between cumulative childhood trauma and mental health problems in children. Perspective matters when examining these variables and child- and caregiver-reports are not interchangeable. Practitioners and researchers should be aware of inherent limitations when using data from distinct perspectives. Informant discrepancies can carry meaning and should not be ignored, but examined and interpreted instead.

Long-term Head Start Impact on developmental outcomes for children in foster care.

PURPOSE: This study examined the long-term effects of Head Start on foster children's developmental outcomes from ages 3-4 to 8-9. METHOD: 187 children in the care of foster parents (either relatives or non-relatives) were selected among 4442 children from the Head Start Impact study data, collected during 2002-2009. Children's cognitive, social-emotional, and health outcomes were measured at three time points: ages 3-4, 5-6, and 8-9. RESULTS: Regression analysis was used to examine interaction effects of Head Start at the three measured time points. Results indicated that children in foster care who participated in Head Start had overall higher cognitive, social-emotional, and health outcomes compared to children in foster care who did not participate in Head Start. The positive impacts of Head Start on children in foster care were more prevalent when children were 8-9 years old. IMPLICATIONS: Social workers should evaluate, identify and connect adequate social services to children in foster care. Future studies should be conducted to identify the barriers of accessing Head Start among children in foster care.

Associations between Traumatic Brain Injury, Drug Abuse, Alcohol Use, Adverse Childhood Events, and Aggression Levels in Individuals with Foster Care History.

Nearly 50,000 Canadian children live in foster care. Compared with their peers, foster children experience greater independence and decreased guidance, predisposing them to harmful exposures such as traumatic brain injury (TBI), illicit drugs, and alcohol. Foster children also report a higher level of childhood abuse compared with the general population. This study aimed to: 1) investigate substance/alcohol use disorder, adverse childhood events (ACE), TBI, aggression levels, and the difference between normalized percentages of brain regions of interest (ROIs) in a sample of Canadian youths with and without foster care history; 2) determine the prevalence of substance/alcohol use disorder, ACE, and aggression levels within individuals with foster care history when stratified by likelihood of TBI; and 3) determine the significant correlates of elevated aggression levels within this population. Participants completed standardized questionnaires that measured the prevalence of TBI, substance and alcohol use disorder, ACE, and aggression. Magnetic resonance imaging (MRI) was used to measure differences in brain ROI. Regression and network analysis were used to study interactions between variables. Seventy-four participants (51 individuals with foster care history and 23 age-matched controls from the general population) completed standardized questionnaires. Fifty-five of these individuals (39 foster participants and 16 controls) underwent brain MRI. Foster participants had higher prevalence of substance use disorder (p < 0.001), alcohol use disorder (p = 0.003), ACE (p < 0.001), and elevated aggression levels (p < 0.001) than healthy controls. No significant difference was found among brain ROI. The prevalence of TBI in foster participants was 65%. Foster participants with moderate or high likelihood of TBI exposure had higher levels of drug use and aggression than those with no or low likelihood of exposure. Brain volumes were not associated with substance/alcohol use disorder or ACE. No significant associations were found between aggression levels and the studied variables.

Validation of ICD-11 PTSD and complex PTSD in foster children using the International Trauma Questionnaire.

OBJECTIVE: ICD-11 introduces post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct trauma-related disorders. Using the International Trauma Questionnaire (ITQ) as disorder-specific measure, this study is the first to examine the factorial and construct validity of ICD-11 PTSD, CPTSD and the ITQs' applicability in children. METHODS: Two hundred and eight Austrian foster children completed a set of standardized measures. Excluding participants who reported not having experienced any kind of trauma, a final sample of 136 children completed the ITQ. Factorial and construct validity of ICD-11 CPTSD and psychometric properties of ITQ scales were assessed by factor analysis and latent class analysis. RESULTS: Confirmatory factor analysis supported the two-factor higher-order model of ICD-11 CPTSD in children by high factor loadings and excellent model fit. Reliability and regression analysis evidenced psychometric adequacy and discriminant validity of ITQ scales. Latent class analysis substantiated construct validity of ICD-11 CPTSD, identifying a CPTSD (22.8%), PTSD (31.6%) and low symptoms class (45.6%). The CPTSD class showed highest rates of childhood trauma, comorbid psychopathology and functional impairment. CONCLUSION: Factorial and construct validity of ICD-11 CPTSD was evidenced in children for the first time using precise descriptions of ICD-11 symptom content, supporting the reliability and validity of the ITQ in children.