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Randomized Controlled Trial
. 2024 Aug;52(8):1183-1192.
doi: 10.1007/s10802-024-01193-x. Epub 2024 Apr 20.

Foster Care Leads to Lower Irritability Among Adolescents with a History of Early Psychosocial Deprivation

Yanbin Niu  1 , George A Buzzell  2 , Ana Cosmoiu  3 , Nathan A Fox  4 , Charles A Nelson  5   6 , Charles H Zeanah  7 , Kathryn L Humphreys  8
Affiliations
Randomized Controlled Trial

Foster Care Leads to Lower Irritability Among Adolescents with a History of Early Psychosocial Deprivation

Yanbin Niu et al. Res Child Adolesc Psychopathol. 2024 Aug.

Abstract

Irritability reflects a propensity for frustration and anger, and is a transdiagnostic symptom of both externalizing and internalizing psychopathology. While early adverse experiences are associated with higher levels of irritability, experiences of early psychosocial deprivation and whether family-based placements can mitigate the impact on subsequent irritability, remain underexplored. The current study examined irritability in 107 16-year-olds with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 49 community comparison children. At age 16 years, irritability was assessed using parent- and self-report forms of the Affective Reactivity Index. Compared to community adolescents, those with a history of institutional care exhibited significantly elevated irritability levels. Among those who experienced institutional care, those randomized to foster care had lower levels of irritability compared to participants randomized to the care-as-usual group, and this effect persists after controlling for baseline negative emotionality. These findings suggest a causal link between high-quality foster care and lower irritability following psychosocial deprivation. Additionally, longer duration in institutional care and non-family placement at age 16 years were associated with higher levels of irritability, highlighting the role of caregiving in explaining variation in irritability in adolescence. Policies that support long-term, high-quality family placements for children without regular caregivers should be prioritized.

Keywords: Adolescence; Early caregiving environment; Institutional care; Irritability.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram showing group placements over time. BEIP = Bucharest Early Intervention Project; ARI C = Child-report form of Affective Reactivity Index; ARI P = Parent-report form of Affective Reactivity Index
Fig. 2
Fig. 2
Affective Reactivity Index (ARI) composite scores at age 16 y as a function of groups. (A) ARI composite scores for those with a history of institutional care (ever-institutionalized) were significantly higher than those never-institutionalized. (B) ARI composite scores were significantly higher in the care-as-usual group (CAUG) than in the foster care group (FCG)
Fig. 3
Fig. 3
Exploratory Analyses. (A) There was a significant association of percent time in institutional care through age 16 with Affective Reactivity Index (ARI) composite scores. Note that care-as-usual group (CAUG) was colored in orange and the foster care group (FCG) was colored in blue. (B) There was a marginally significant difference in ARI composite scores between children who had stable placement in foster care and those who experienced a placement disruption by age 16 years. (C) Residing with a family was significantly associated with ARI composite scores
See this image and copyright information in PMC

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