The Effect of Foster Care on Social Skills

Abstract

Almas AN, Degnan KA, Radulescu A, et al. Effects of early intervention and the moderating effect of brain activity on institutionalized children’s social skills at age 8. PNAS. 2012; 10(Suppl 2): 17228-17231; doi: 10.1073/pnas.1121256109Investigators from multiple institutions sought to understand the effect of early foster care placement on the social skills of previously institutionalized children when they reached middle childhood. This study was part of the Bucharest Early Intervention Project (BEIP) that began in 2001. BEIP is a randomized controlled trial of foster care as an intervention for children abandoned at birth and placed in 1 of 6 institutions for young children in Bucharest, Romania. At the outset of the BEIP, 136 institutionalized children were randomized to either foster care or usual care in the institution in which they currently resided. Children who were randomized to foster care were initially placed at ages 7 to 35 months. A control group of non-institutionalized children from the Bucharest community were also enrolled and were matched on age and gender to children in the intervention groups.For the current study, children had their attachment security to a primary caregiver (foster mother or favorite caregiver in the institution) assessed by the preschool version of the Strange Situation Procedure when they were 42 months old. When participants were 8 years old, brain electrical activity (EEG) was obtained; EEG power in the alpha band (7-12 Hz) was computed, since alpha activity is associated with attention and processing of sensory information and high alpha power reflects cortical maturity.1 The primary outcome was social skills which were measured by administering the Social Skills Rating System (SSRS) to their teachers when the children were 8 years old. Social skills of children in each of the 3 groups were compared, and the effects of age at foster care placement, EEG alpha power, and attachment security on this outcome were assessed.In the present study, there were 44 children in the usual care group, 52 in the foster care group, and 97 in the control group. Only 12 children in the usual care group were still living in an institution at age 8 years. Overall, children in the control group were rated significantly higher on social skills than children in the foster care and usual care groups. However, children placed in foster care before 20 months of age were rated no differently on social skills than control children and were rated significantly higher than usual care children. High EEG power in the alpha band among usual care and foster care children was significantly associated with better attachment security and social skills. There was no significant relationship between attachment security and social skills in usual care and foster care children who had low EEG power in the alpha band.The authors conclude that forming secure foster care relationships positively influences social skills of children who have experienced severe social deprivation from early institutionalization, and that alpha electrical activity appears important in the relationship between attachment and social skills.Middle childhood is a period of increasing interest to both foster and adoptive parents because poor social skills at this critical time in a child’s life can lead to rejection and exclusion by their peers during the transition to adolescence.2 Wiik et al recently reported that postinstitutionalized children have a greater risk of attention-deficit hyperactivity disorder symptoms and emotional or internalizing behavioral disorders than children in foster care/minimal institutionalization and control children (see AAP Grand Rounds, June 2011;25[6]:623). Erol et al found that institutionalized adolescents with few friends and poor relationships have more internalizing and externalizing problem behaviors, which can persist into and complicate their adulthood.4In the current study the BEIP provided researchers a unique opportunity to evaluate how variations in attachment relationships can influence the negative impact of early institutionalization. The investigators have proffered evidence that foster care has the expected positive influence on the social development of children who have experienced deprivation, as long as the intervention occurs early enough in life. However, the results also demonstrate that future research must consider other factors, such as brain development, which can dramatically affect the attachment-social skills relationship.Life is full of limited time offers. For institutionalized children, this study now helps pinpoint the deadline (ie, 20 months of age) after which a critical intervention may no longer change the future bleak outcome and direction of a child’s life. And, like the hidden catches in many of these limited time offers, there is no guarantee that a good intervention will result in the desired outcome.