CoChat
Sign Up
Cited by 133Child Welfare and AdoptionAttachment and Relationship DynamicsChild and Adolescent Psychosocial and Emotional Development

Recovering from early deprivation: attachment mediates effects of caregiving on psychopathology

Open access
McGoron, Lucy, Gleason, Mary Margaret, Smyke, Anna T., Drury, Stacy S., Nelson, Charles A., Gregas, Matthew C., Fox, Nathan A., Zeanah, Charles H.·2012·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2012.05.004PMC PMC4127424
Open this paper in CoChat — free accountOpen PDF

Abstract

Objective Children exposed to early institutional rearing are at risk for developing psychopathology. The present investigation examines caregiving quality and the role of attachment security as they relate to symptoms of psychopathology in young children exposed to early institutionalization.Method Participants were enrolled in the Bucharest Early Intervention Project (BEIP), a longitudinal intervention study of children abandoned and placed in institutions at or shortly after birth. Measures included observed caregiving when children were 30 months of age, observed attachment security at 42 months, and caregiver reports of children's psychopathology at 54 months. At 54 months, some children remained in institutions, others were in foster care, others had been adopted domestically, and still others had been returned to their biological families. Thus, the children had experienced varying amounts of institutional rearing.Results After controlling for gender, quality of caregiving when children were 30 months old was associated with symptoms of multiple domains of psychopathology at 54 months of age. Ratings of security of attachment at 42 months mediated the associations between quality caregiving at 30 months and fewer symptoms of psychopathology at 54 months.Conclusions Among deprived young children, high-quality caregiving at 30 months predicted reduced psychopathology and functional impairment at 54 months. Security of attachment mediated this relationship. Interventions for young children who have experienced deprivation may benefit from explicitly targeting caregiver-child attachment relationships.

Integrity signals

Registry

Crossref · 10.1016/j.jaac.2012.05.004

Cites

56 of 56 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 62 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Boys had more symptoms of indiscriminately social/disinhibited RAD than girls.

    “Boys were reported to have more symptoms of indiscriminately social/disinhibited RAD (t [119.82] = −2.27, p < .05), more symptoms of externalizing disorders (t [115.84] = −3.08, p < .01), more symptoms of internalizing disorders (t [118] = −2.71, p < .01), and more functional impairment (t [108.65] = −2.67, p < .01) compared to girls.”
    Quote in the paperNot a substantial claim
  • Findingown data

    When gender was controlled, the quality of caregiving measured at 30 months related to symptoms across several psychopathology domains at 54 months.

    “After controlling for gender, quality of caregiving when children were 30 months old was associated with symptoms of multiple domains of psychopathology at 54 months of age.”
    Quote in the paperSubstantial claim
  • Findingown data

    Boys had more externalizing symptoms than girls.

    “Boys were reported to have more symptoms of indiscriminately social/disinhibited RAD (t [119.82] = −2.27, p < .05), more symptoms of externalizing disorders (t [115.84] = −3.08, p < .01), more symptoms of internalizing disorders (t [118] = −2.71, p < .01), and more functional impairment (t [108.65] = −2.67, p < .01) compared to girls.”
    Quote in the paperNot a substantial claim
  • Findingown data

    No baseline characteristics of children (birthweight, emotional responsiveness, or attachment status) had any effects on results.

    “No baseline characteristics of children (i.e., birthweight, emotional responsiveness, or attachment status) had any effects on results and are not included in the analyses of mediation.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Attachment security at 42 months mediated the association between caregiving quality at 30 months and fewer symptoms of psychopathology at 54 months.

    “Ratings of security of attachment at 42 months mediated the associations between quality caregiving at 30 months and fewer symptoms of psychopathology at 54 months.”
    • Also stated in: § Conclusions · plain
      “Security of attachment mediated this relationship.”
    Quote in the paperSubstantial claim
  • May combine two claims. 18
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 27

  • May combine two claims.

    Findingown data

    All outcome variables were related to one another except that 54-month symptoms of emotionally withdrawn/inhibited RAD was not related to symptoms of externalizing disorders.

    “All outcome variables were found to be related to one another with the exception that 54-month symptoms of emotionally withdrawn/inhibited RAD was not related to symptoms of externalizing disorders.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    After statistically controlling for 42-month attachment security, the association between 30-month caregiving quality and 54-month indiscriminately social/disinhibited RAD symptoms was no longer statistically significant (β = −.16, n.s.).

    “after controlling for 42-month attachment security the association between 30-month attachment security and indiscriminately social/disinihibted RAD at 54 months was no longer statistically significant (β = −.16, n.s.; Table 4; Figure 1).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    No statistically significant ethnicity differences emerged.

    “No statistically significant ethnicity differences emerged.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The outcomes in this study are moderately to strongly interrelated.

    “The outcomes in this study are moderately to strongly interrelated”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Attachment security at 42 months had negative main effects on symptoms of emotionally withdrawn/inhibited RAD, stereotypic movement disorder, externalizing disorders, internalizing disorders, and functional impairment at 54 months.

    “Statistically significant and negative main effects also emerged between 42-month attachment security and symptoms of emotionally withdrawn/inhibited RAD, symptoms of stereotypic movement disorder, symptoms of externalizing disorders, symptoms of internalizing disorders, and functional impairment (Table 4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For symptoms of emotionally withdrawn/inhibited RAD, internalizing disorders, and functional impairment at 54 months, the association with 30-month caregiving quality remained statistically significant when controlling for 42-month attachment security, but the strength of the relationship was reduced.

    “The association between 30-month caregiving quality and symptoms of emotionally withdrawn/inhibited RAD, symptoms of internalizing disorders and functional impairment at 54 months remained statistically significant when statistically controlling for 42-month attachment, but there was a reduction in the strength of the relationship (Table 4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For emotionally withdrawn/inhibited RAD, both a main effect of 42-month attachment security and an interactive effect emerged.

    “For emotionally withdrawn/inhibited RAD, both a main effect of 42-month attachment security and an interactive effect emerged.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Caregiving quality at 30 months was negatively associated with symptoms of emotionally withdrawn/inhibited RAD, stereotypic movement disorder, externalizing disorders, internalizing disorders, and functional impairment at 54 months.

    “Statistically significant and negative associations emerged between 30-month caregiving quality and symptoms of emotionally withdrawn/inhibited RAD, symptoms of stereotypic movement disorder, symptoms of externalizing disorders, symptoms of internalizing disorders, and functional impairment (Table 3)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For each indicator of psychopathology and for functional impairment, the bias-corrected bootstrap confidence intervals of the indirect effects did not cross zero, consistent with the mediation hypotheses.

    “These results are presented in Table 4, and all are consistent with the mediation hypotheses because the bias-corrected confidence intervals do not cross zero.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    Scores for symptoms of emotionally withdrawn/inhibited and indiscriminately social/disinhibited RAD converge with other caregiver report measures of the same constructs and with observed behavior.

    “Furthermore, scores for symptoms of emotionally withdrawn/inhibited and symptoms of indiscriminately social/disinhibited RAD scale converge with other caregiver report measures of the same constructs 32, 34 and with observed behavior.32, 36”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [32] Gleason, 2011, The validity of evidence-derived criteria for reactive attachment disorder: indiscriminately social/disinhibited and emotionally withdrawn/inhibited type, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

    • cites [34] Zeanah, 2002, Attachment disturbances in young children, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

    • cites [36] Zeanah, 2005, Attachment in institutionalized and community children in Romania, Child Dev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Children placed in foster care in the BEIP had significantly fewer symptoms of internalizing disorders, attachment disorders, and stereotyped movement disorders than children who continued institutional care.

    “To date, investigators have reported that children placed in foster care had significantly fewer symptoms of internalizing disorders, 6 attachment disorders, 21 and stereotyped movement disorders 22 compared to children receiving continued institutional care.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [6] Zeanah, 2009, Institutional rearing and psychiatric disorders in Romanian preschool children, Am J Psychiatry source

      Not checked in the free run.

    • cites [21] Smyke AT, Zeanah CH, Gleason MM, et al. A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder [published online ahead of print March 8, 2012]. Am J Psychiatry. doi: 10.1176/appi.ajp.2011.11050748. source

      Not checked in the free run.

    • cites [22] Bos, 2010, Stereotypies in children with a history of early institutional care, Arch Pediatr Adolesc Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Baron and Kenny require that the association between mediator and outcome is found even when statistically controlling for predictor.

    “Baron and Kenny39 require that this association is found even when statistically controlling for the predictor variable (30-month caregiving quality).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Baron, 1986, The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations, J Pers Soc Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Data were available on 126 children and caregivers at 30 months, 126 at 42 months, and 123 children at 54 months.

    “For the present study, data were available on 126 children and their caregivers at 30 months, 126 children and their caregivers at 42 months, and 123 children at 54 months.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Attachment security was rated by trained coders who were blind to children's status (FCG vs. CAUG).

    “In addition to classifications of attachment, attachment security was rated as a continuous variable by trained coders who were blind to children’s status (FCG vs. CAUG).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Interrater reliability for attachment security scale was ICC=.87.

    “Interrater reliability for this scale was excellent (ICC = .87).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    The SSP is a widely used and validated measure of children's attachment security.

    “The SSP is a widely used and validated measure of children’s attachment security.30”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Ainsworth, 1978

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Inter-rater reliability for caregiving quality was ICC=0.75 and scale reliability Cronbach's α=.86.

    “Inter-rater reliability (ICC= 0.75) and scale reliability (Cronbach’s α = .86) were more than adequate.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Gender was statistically controlled in all analyses testing study hypotheses.

    “Given the presence of gender differences, gender was statistically controlled for in all analyses testing study hypotheses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    The original study population was randomized to care as usual or foster care, but local Commissions on Child Protection made all placement decisions and many children changed status.

    “Although the original study population was randomized to care as usual or foster care, the local Commissions on Child Protection made all decisions about placements, and there were many changes in status for a large number of the children in the study (See Table 1).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    There is an extensive literature on the association between caregiving quality and attachment security.

    “First, there is an extensive literature on the association between caregiving quality and security of attachment.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [23] Belsky, 2008, Precursors of attachment security

      Not checked in the free run.

    • cites [24] Green, 2002, Annotation: Attachment disorganisation and psychopathology: new findings in attachment research and their potential implications for developmental psychopathology in childhood, J Child Psychol Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    In the BEIP, children were randomly assigned to foster families or to care as usual, which mostly meant continued institutional placement.

    “Following detailed baseline assessments, the children were randomly assigned to placement in foster families or to care as usual, which mostly meant continued institutional placement.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    75% of SSPs were double coded to assess reliability.

    “The continuous scores were used in the present study, and 75% of the SSPs were double coded to assess reliability.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The PAPA has adequate test-retest reliability.

    “Egger and colleagues38 found that the PAPA has adequate test-retest reliability.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Egger, 2006, Test-retest reliability of the Preschool Age Psychiatric Assessment (PAPA), J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Scale reliability for symptoms of emotionally withdrawn/inhibited RAD was acceptable (Cronbach's α = .84).

    “Scale reliability was also found to be acceptable (Cronbach’s α = .84).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Trained coders who rated caregiver and child behavior were unaware of the study design.

    “Trained coders who knew only that they were coding behaviors of caregivers and children in different settings and who were unaware of the study design rated behavior of children and caregivers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Kraemer et al. suggest a main or interactive effect can exist between mediator and outcome.

    “Furthermore, Kraemer et al.40 suggest a main or interactive effect can exist between the mediator variable (42-month attachment security) and the outcome variable (54-month psychopathology).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Kraemer, 2001, How do risk factors work together?, Am J Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Kraemer et al. specify that to demonstrate mediation a temporal association must exist between predictor and mediator and this association must be statistically significant.

    “Kraemer et al.40 specify that to demonstrate mediation a temporal association must exist between the predictor variable (30-month caregiving quality) and the mediator variable (42-month attachment security) and this association must be statistically significantly.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Kraemer, 2001, How do risk factors work together?, Am J Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Scale reliability for symptoms of indiscriminately social/disinhibited RAD was acceptable (Cronbach's α = .81).

    “Scale reliability for symptoms of indiscriminately social/disinhibited RAD was acceptable (Cronbach’s α = .81).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Secure attachment behaviors in young children are thought to reflect a child's internal perception of the predictability and protection by the caregiver and are associated with enhanced emotion and behavioral regulation abilities, socially engaging behaviors, and social competence.

    “Secure attachment behaviors in young children are thought to reflect a child’s internal perception of the predictability and protection by his/her caregiver and are known to be associated with enhanced emotion and behavioral regulation abilities, socially engaging behaviors, and social competence.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] DeKlyen, 2008, Attachment and psychopathology in childhood

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An attachment-focused intervention for foster parents was effective in enhancing attachment and normalizing cortisol patterns in maltreated children.

    “an attachment-focused intervention for foster parents was effective in enhancing attachment and normalizing cortisol patterns in maltreated children.46, 47”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [46] Dozier, 2008, Effects of an attachment-based intervention on the cortisol production of infants and toddlers in foster care, Dev Psychopathol source

      Not checked in the free run.

    • cites [47] Fisher, 2000, Preventive intervention for maltreated preschool children: impact on children's behavior, neuroendocrine activity, and foster parent functioning, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Genetic factors play a role in the development of psychopathology in children with a history of early deprivation.

    “genetic factors, which the present investigation did not consider, play a role in the development of psychopathology in children with a history of early deprivation (see Drury et al. 45 and Kumsta et al.43).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Drury et al. 45

      Not checked in the free run.

    • cites Kumsta et al.43

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Even in older toddlers, providing enhanced caregiving relationships is associated with increasing attachment security and measurably better outcomes.

    “these results emphasize that even in older toddlers, providing enhanced caregiving relationships is associated with increasing security and measurably better outcomes.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The study used a longitudinal design with assessments at 30, 42, and 54 months of age.

    “A significant strength of the current investigation is the use of a longitudinal design. Assessments took place when children were 30, 42, and 54 months old.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Symptoms of psychopathology in this study were assessed through caregiver report alone.

    “symptoms of psychopathology were assessed through caregiver report alone.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Factors beyond caregiving quality and attachment security that were not examined may have contributed in important ways to the reduced risk for psychopathology observed.

    “we caution that other factors beyond caregiving quality and security of attachment that we did not examine may have contributed in important ways to the reduce risk for psychopathology that we observed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The current attachment relationship may be an important, modifiable target of interventions to prevent the development of psychopathology in high-risk children.

    “our results suggest that the current attachment relationship may be an important, modifiable target of interventions to prevent the development of psychopathology in high-risk children.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The development of secure attachment relationships may be associated with reduced symptoms of psychopathology through intermediate developmental effects.

    “According to DeKlyen and Greenberg,25 the development of secure attachment relationships may be associated with reduced symptoms of psychopathology through intermediate developmental effects.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites DeKlyen and Greenberg,25

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Early adversity is associated with psychopathology.

    “This finding is consistent with the growing literature demonstrating an association between early adversity and psychopathology, 43”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Kaplow, 2007, Age of onset of child maltreatment predicts long-term mental health outcomes, J Abnorm Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Multifinality, a single risk or protective factor related to multiple outcomes, is well known in developmental psychopathology research.

    “Multifinality, describing a single risk or protective factor that is related to multiple outcomes, is well known in developmental psychopathology research44.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Ciccheti, 1996, Equifinality and multifinality in developmental psychopathology, Dev Psychol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The results underscore the behavioral plasticity of attachment in young children and its relation to subsequent psychopathology.

    “these results also underscore the behavioral plasticity of attachment in young children and its relation to subsequent psychopathology.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study used both observational ratings and structured interviews to obtain data on this sample.

    “Another strength was using both observational ratings and structured interviews to obtain data on this sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Birth and prenatal records were quite limited, making formal assessment of prenatal risk factors impossible.

    “birth and prenatal records were quite limited, making formal assessment of prenatal risk factors impossible.”
    Quote in the paperNot a substantial claim
42 of 42

  • The paper relies on this without support.

    The direct link between caregiving quality and psychopathology in institutionalized children has not been studied.

    “the direct association between caregiving quality and psychopathology remains unexplored.”

  • The paper relies on this without support.

    The mechanisms connecting caregiving quality and psychopathology are not known.

    “Mechanisms linking caregiving quality and psychopathology also remain unclear.”

  • The paper relies on this without support.

    It is unclear whether the association between caregiving and attachment security applies to children who experienced institutional care in early childhood.

    “Although the association between caregiving and attachment security has been established in many studies, whether this same relation exists in children exposed to institutional care in early childhood is less clear.”

  • The paper relies on this without support.

    Sensitive, responsive caregiving creates expectations in young children that their emotional needs will be met.

    “Sensitive, responsive caregiving is thought to create expectations in young children that their emotional needs will be met.”

  • The paper relies on this without support.

    Greater security of attachment protects against psychopathology.

    “This in turn is believed to lead to greater security of attachment, which in turn is believed to protect against psychopathology.”

  • The paper relies on this without support.

    Caregiver sensitivity is responsive to intervention and affects attachment security.

    “perhaps with special attention to sensitivity, which is known to be responsive to intervention and to impact attachment.”

  • The paper relies on this without support.

    Caregiver report validly captures children's symptoms of psychopathology in this sample.

    “symptoms of psychopathology were assessed through caregiver report alone.”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Bootstrapping method cites the wrong reference

    Minor

    The results attribute the bootstrapping procedure to Preacher and Hayes but cite reference 40, which lists Kraemer and colleagues. Preacher and Hayes are listed as reference 41.

  • Attachment security is assigned two different assessment ages

    Minor

    The results describe attachment security as measured at 30 months, but the methods specify that it was measured at 42 months. The surrounding analysis also treats 42-month attachment security as the mediator.

  • Genetics discussion misidentifies reference 43

    Minor

    The discussion cites reference 43 as work by Kumsta and colleagues, but reference 43 lists Kaplow and Widom.

3 of 3

Cites

Flagged first, then by citations

1 of the 57 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
McGoron, L., Gleason, M. M., Smyke, A. T., Drury, S. S., Nelson, C. A., Gregas, M. C., Fox, N. A., & Zeanah, C. H.
Affiliations
  • LSU New Orleans (US)
  • Tulane University (US)
  • Harvard University (US)
  • University of Maryland, College Park (US)
Corresponding author
Zeanah, Charles H.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2012-07
Volume
51
Issue
7
Pages
683-693
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2012.05.004
PMC
PMC4127424
OpenAlex
W2147913194
Cited by
133
References
57
Citations by year
2026: 1 · 2025: 2 · 2024: 6 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 17 · 2019: 33 · 2018: 11 · 2017: 13 · 2016: 8 · 2015: 10 · 2014: 12 · 2013: 3 · 2012: 1
FWCI
21.61
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health
  • National Science Foundation
  • University of New Orleans Office of Research
  • Tulane University Clinical and Translational Research Education Center
  • NIMH
  • Substance Abuse and Mental Health Service Administration
  • National Institutes of Health
  • National Institute of Environmental Health Sciences
  • National Alliance for Research on Schizophrenia and Depression
  • Hyundai
  • Louisiana Board of Regents
  • Harvard University
  • NIH
  • Simons Foundation
  • Autism Speaks
  • John D. and Catherine T. MacArthur Foundation
  • Sinneave Family Foundation
  • Thrasher Foundation
  • National Institute on Deafness and Other Communication Disorders
  • Department of Defense
  • Fidelity Foundation
  • Harris Foundation
  • SAMHSA
Topics
  • Social Sciences › Safety Research › Child Welfare and Adoption
  • Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
child deprivation, caregiving quality, attachment security, psychopathology, Bucharest Early Intervention Project, foster care, adoption, institutionalized children, mediation, early intervention
MeSH terms
Adoption, Affective Symptoms, Mental Disorders, Child Behavior Disorders, Child, Abandoned, Child, Institutionalized, Child, Preschool, Female, Foster Home Care, Humans, Infant, Infant, Newborn, Inhibition, Psychological, Interview, Psychological, Life Change Events, Longitudinal Studies, Male, Object Attachment, Psychopathology, Psychosocial Deprivation, Romania, Social Behavior Disorders, Social Environment, Caregivers, Early Intervention, Educational, Orphanages, Stereotypic Movement Disorder, Reactive Attachment Disorder

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review