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Cited by 70Child Welfare and AdoptionAutism Spectrum Disorder ResearchFamily and Disability Support Research

Social communication difficulties and autism in previously institutionalized children

Open access
Levin, April R., Fox, Nathan A., Zeanah, Charles H., Nelson, Charles A.·2015·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2014.11.011PMC PMC4404759
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Abstract

Objective To determine the risk of difficulties with social communication and restricted/repetitive behaviors as well as the rate of autism in children institutionalized in early infancy and to assess the impact of a foster care intervention on ameliorating this risk.Method Children abandoned at birth and raised in institutions in Bucharest, Romania were randomly assigned to a care-as-usual group (institutional care, CAUG), or placed in family-centered foster care (FCG) as part of the Bucharest Early Intervention Project (BEIP). At approximately 10 years of age, the Social Communication Questionnaire (SCQ) was administered to caregivers of children in both groups as well as to parents of a typically developing community sample (Never-Institutionalized group [NIG]) residing in Bucharest, Romania. Children scoring ≥12 on the SCQ underwent clinical evaluation for autism spectrum disorder (ASD).Results Caregivers of children with a history of institutionalization reported that these children had significantly more deviant behavior than never-institutionalized children on all subdomains of the SCQ (all p < 0.001). Children in the FCG had significantly lower scores on the SCQ than children in the CAUG (p < .001), particularly in the reciprocal social interaction domain, indicating that the intervention reduced problems in social communication. Three of 60 CAUG children, 2 of 57 FCG children, and none of the NIG children received a formal ASD diagnosis.Conclusion Early institutional rearing was associated with an increased risk of social communication difficulties and ASD. A family-centered foster care intervention improved social communication skills.

AI snapshot

Written from the paper’s full text.

TL;DR

In the Bucharest Early Intervention Project, children with a history of institutional rearing had more social communication difficulties and restricted/repetitive behaviors than never-institutionalized children, and a foster care intervention improved social communication. Five of 117 ever-institutionalized children met DSM criteria for ASD, whereas none of the never-institutionalized comparison children did.

Key findings

  • Caregivers of ever-institutionalized children reported significantly more deviant SCQ behavior than never-institutionalized children on all SCQ subdomains (all p<0.001).
  • Children in the foster care group had significantly lower SCQ scores than children in the care-as-usual group (p<.001), particularly in the reciprocal social interaction domain; communication and restricted/repetitive behavior domains did not differ significantly between CAUG and FCG.
  • The Results section reports ASD diagnoses in 3 of 57 CAUG children, 2 of 60 FCG children, and 0 of 100 NIG children; the Discussion states 5 of 117 ever-institutionalized children met DSM criteria, approximately a 3-fold increase over what would be expected in a typical community sample.
  • SCQ scores correlated with total percentage of life spent in an institution even after controlling for demographics and birth history (R² = .141, B = .110, SE = .029, β = .381), but did not significantly correlate with number of placement transitions.

Methods

  • The study used the Bucharest Early Intervention Project, a randomized controlled trial: 136 ever-institutionalized Romanian children were randomly assigned to continued institutional care-as-usual (CAUG) or family-centered foster care (FCG), with a never-institutionalized community comparison group (NIG) matched by age and gender.
  • At approximately 10 years of age (mean 10, range 8–11), caregivers completed the Social Communication Questionnaire (SCQ); children scoring ≥12 underwent clinical evaluation for ASD, and two additional children were referred by BEIP psychologists for clinical concern.
  • Analyses included two-tailed t-tests, linear regression, ANOVA with post hoc Bonferroni correction, and Pearson correlations; ASD diagnoses used DSM-IV criteria, with re-analysis using DSM-5 criteria showing no change in the number diagnosed.

Limitations

  • The paper states that abandonment itself was not random, so the study cannot separate effects of institutionalization from genetic and prenatal factors that increase both abandonment risk and ASD risk.
  • The paper states that the non-interference policy led many CAUG children to later move to government foster care or biological families, likely underestimating the impact of foster care placement on SCQ scores; parent-report SCQ also allows observer bias, and the small ASD numbers cannot determine whether CAUG versus FCG significantly affects ASD rates.
  • The text makes evident that SCQ data were collected at a single time point, so the study cannot evaluate change over time, and the small ASD sample limits definitive statements about quasi-autism; none of the children who received an ASD diagnosis had WISC scores available.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jaac.2014.11.011

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 39 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    History of institutionalization was associated with higher SCQ scores across all domains.

    “History of institutionalization was associated with higher SCQ scores across all domains.”
    Quote in the paperSubstantial claim
  • Findingown data

    After controlling for demographics and birth history by regression, group status (CAUG, FCG, or NIG) was still a significant predictor of SCQ score.

    “After controlling for demographics and birth history by regression, group status (CAUG, FCG, or NIG) was still a significant predictor of SCQ score (see Table S1, available online).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: SCQ scores are comparable across different types of caregivers (institutional caregivers, foster parents, biological parents).
  • Findingown data

    SCQ score was significantly associated with full scale IQ score, and each IQ subtest, in the FCG group.

    “Pearson correlations revealed that SCQ score was significantly associated with full scale IQ score, and each IQ subtest, in the FCG group.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: SCQ scores are comparable across different types of caregivers (institutional caregivers, foster parents, biological parents).
  • Findingown data

    ANOVA revealed a significant between-group difference in SCQ score (F(3,91) = 4.96, p = .003).

    “ANOVA revealed a significant between-group difference in SCQ score (F(3,91) = 4.96, p = .003).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: SCQ scores are comparable across different types of caregivers (institutional caregivers, foster parents, biological parents).
  • Findingown data

    SCQ scores were not significantly correlated with SSRS scores for academic competence.

    “SCQ scores were not significantly correlated with SSRS scores for academic competence (see Table S2, available online).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: SCQ scores are comparable across different types of caregivers (institutional caregivers, foster parents, biological parents).
  • May combine two claims. 20
  • Classified as probably not a substantial claim. 11

  • May combine two claims.

    Findingown data

    Three of 60 CAUG children, 2 of 57 FCG children, and none of the NIG children received a formal ASD diagnosis.

    “Three of 60 CAUG children, 2 of 57 FCG children, and none of the NIG children received a formal ASD diagnosis.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The ASD diagnostic evaluation was not biased by knowledge of the child's group assignment.

  • May combine two claims.

    Findingown data

    3 of 57 CAUG children, 2 of 60 FCG children, and 0 of 100 NIG children met DSM-IV (and DSM-5) criteria for ASD.

    “3 of 57 CAUG children, 2 of 60 FCG children, and 0 of 100 NIG children met DSM-IV (and DSM-5) criteria for ASD.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The ASD diagnostic evaluation was not biased by knowledge of the child's group assignment.

  • May combine two claims.

    Findingown data

    Caregivers of children in the EIG reported higher scores (more problems) on the SCQ overall, and on each subdomain of the SCQ, than caregivers of children in the NIG.

    “Caregivers of children in the EIG reported higher scores (more problems) on the SCQ overall, and on each subdomain of the SCQ, than caregivers of children in the NIG (Table 1).”
    • Also stated in: § Results · plain
      “Caregivers of children with a history of institutionalization reported that these children had significantly more deviant behavior than never institutionalized children on all subdomains of the SCQ (all p<0.001).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: SCQ scores are comparable across different types of caregivers (institutional caregivers, foster parents, biological parents).

  • May combine two claims.

    Findingown data

    Post hoc Bonferroni analysis yielded significant differences (p < .05) in SCQ score between children living in institutions at the time of the study and those living in family-based care, but no significant differences in SCQ score between children in the various types of family-based care (biological family, government foster care, or BEIP foster care).

    “Post hoc Bonferroni analysis yielded significant differences (p < .05) in SCQ score between children living in institutions at the time of the study and those living in family-based care, but no significant differences in SCQ score between children in the various types of family-based care (biological family, government foster care, or BEIP foster care; Table 2).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: SCQ scores are comparable across different types of caregivers (institutional caregivers, foster parents, biological parents).

  • May combine two claims.

    Findingown data

    Scores in the communication domain, and the restricted/repetitive behaviors domain, were not significantly different between CAUG and FCG.

    “Scores in the communication domain, and the restricted/repetitive behaviors domain, were not significantly different between CAUG and FCG (Table 1).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: SCQ scores are comparable across different types of caregivers (institutional caregivers, foster parents, biological parents).

  • May combine two claims.

    Findingown data

    SCQ score was not significantly associated with full scale IQ score, or any IQ subtest, in the CAUG or NIG groups.

    “SCQ score was not significantly associated with full scale IQ score, or any IQ subtest, in the CAUG or NIG groups (see Table S3, available online).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: SCQ scores are comparable across different types of caregivers (institutional caregivers, foster parents, biological parents).

  • May combine two claims.

    Findingown data

    Within the EIG, SCQ scores correlated with the total percentage of a child's life spent in an institution, even when controlling for demographics and birth history; children who had spent a longer period of their lives in an institution at age 8 had higher SCQ scores.

    “However, scores did correlate with the total percentage of a child’s life spent in an institution, even when controlling for demographics and birth history (R2 = .141, B = .110, Standard Error = .029, β = .381).”
    • Also stated in: § SCQ Scores · plain
      “Children who had spent a longer period of their lives in an institution at age 8 had higher SCQ scores.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    2/5 children with ASD in the sample are female.

    “2/5 children with ASD in our sample are female”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    It is unlikely that ASD was a reason for abandonment of children in this study; instead, political pronatalist policies in the context of frequently insufficient financial and social support for child rearing led many children to be abandoned for social reasons.

    “it is unlikely that ASD was a reason for abandonment; instead, political pronatalist policies in the context of frequently insufficient financial and social support for child rearing led many children to be abandoned for social reasons.20, 21”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [20] Kligman, 1992, The politics of reproduction in Ceausescu’s Romania: a case study in political culture, East Eur Polit Soc source

      Not checked in the free run.

    • cites [21] Greenwell, 2006, The impact of child welfare reform on child abandoment and deinstitutionalization, Romania 1990-2000, Ann Demogr Hist (Paris)

      Not checked in the free run.

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

    Premisecitation

    Children with a history of institutionalization have an increased likelihood of demonstrating repetitive movements such as stereotypies.

    “Children with a history of institutionalization also have an increased likelihood of demonstrating repetitive movements such as stereotypies.17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Bos, 2010, Stereotypies in children with a history of early institutional care, Arch Pediatr Adolesc Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Prior studies in the BEIP have specifically examined attachment, teacher-rated social skills, and stereotypies, but these findings are not always specific to ASD.

    “While prior studies in the BEIP have specifically examined attachment,15, 23, 24 teacher-rated social skills,16 and stereotypies,17 these findings are not always specific to ASD.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [15] Smyke, 2012, A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder, Am J Psychiatry source

      Not checked in the free run.

    • cites [23] Smyke, 2010, Placement in foster care enhances quality of attachment among young institutionalized children, Child Dev source

      Not checked in the free run.

    • cites [24] Zeanah, 2005, Attachment in institutionalized and community children in Romania, Child Dev source

      Not checked in the free run.

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

    Premisecitation

    Within institutions, medical determination of whether a child was "typically developing" or "handicapped" generally did not occur until the age of 3 years.

    “Within institutions, medical determination of whether a child was “typically developing” or “handicapped” generally did not occur until the age of 3 years.22”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Johnson, 2014, The health of children adopted from Romania, J Am Med Assoc source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Quasi-autism and PIAS differ from ordinary ASD in having a general trend for decreasing severity of ASD features over time and an equal male:female ratio, compared to the 4:1 male:female ratio seen on average in other studies of ASD.

    “These features include a general trend for decreasing severity of ASD features over time and an equal male:female ratio (compared to the 4:1 male:female ratio seen on average in other studies of ASD).8”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Fombonne, 2003, Epidemiological surveys of autism and other pervasive developmental disorders: an update, J Autism Dev Disord source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Post-institutionalized children demonstrate behaviors often seen in ASD, including abnormalities in social approach, difficulties adjusting behavior to suit social context, and difficulties with peer relationships.

    “Other studies, while not looking specifically at ASD, suggest that post-institutionalized children demonstrate behaviors often seen in ASD, including abnormalities in social approach, difficulties adjusting behavior to suit social context, and difficulties with peer relationships.4, 9–16”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [4] Rutter, 2007, Early adolescent outcomes for institutionally-deprived and non-deprived adoptees. I: disinhibited attachment, J Child Psychol Psychiatry source

      Not checked in the free run.

    • cites [9] Hodges, 1989, Social and family relationships of ex-institutional adolescents, J Child Psychol Psychiatry source

      Not checked in the free run.

    • cites [10] Chisholm, 1998, A three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages, Child Dev source

      Not checked in the free run.

    • cites [11] MacLean, 2003, The impact of institutionalization on child development, Dev Psychopathol source

      Not checked in the free run.

    • cites [12] Roy, 2004, Institutional care: associations between overactivity and lack of selectivity in social relationships, J Child Psychol Psychiatry source

      Not checked in the free run.

    • cites [13] Gunnar, 2007, Behavior problems in postinstitutionalized internationally adopted children, Dev Psychopathol source

      Not checked in the free run.

    • cites [14] Erol, 2010, Mental health of adolescents reared in institutional care in Turkey: challenges and hope in the twenty-first century, Eur Child Adolesc Psychiatry source

      Not checked in the free run.

    • cites [15] Smyke, 2012, A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder, Am J Psychiatry source

      Not checked in the free run.

    • cites [16] Almas, 2012, Effects of early intervention and the moderating effects of brain activity on institutionalized children’s social skills at age 8, Proc Natl Acad Sci U S A source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Children raised in institutions are at increased risk for a variety of adverse outcomes, including quasi-autistic patterns of behavior.

    “Children raised in institutions are at increased risk for a variety of adverse outcomes,1 including risk for “quasi-autistic” patterns of behavior.2, 3”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] Nelson, 2014

      Not checked in the free run.

    • cites [2] Rutter, 1999, Quasi-autistic patterns following severe early global privation, J Child Psychol Psychiatry source

      Not checked in the free run.

    • cites [3] Rutter, 2007, Early adolescent outcomes of institutionally deprived and non-deprived adoptees. III. Quasi-autism, J Child Psychol Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    No study has previously addressed the broad range of difficulties with social communication and restricted/repetitive behaviors specifically seen in ASD, nor the specific diagnosis of ASD, in a randomized sample.

    “No study has previously addressed the broad range of difficulties with social communication and restricted/repetitive behaviors specifically seen in ASD, nor the specific diagnosis of ASD, in a randomized sample.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All initial analyses in the current paper follow an intent-to-treat model, with children considered within their original assigned group.

    “All initial analyses in the current paper follow an intent-to-treat model, with children considered within their original assigned group.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    The Social Communication Questionnaire (SCQ) is a validated parent-report screening measure that assesses for symptomatology associated with ASD.

    “The Social Communication Questionnaire (SCQ; Western Psychological Services, 2003) is a validated parent-report screening measure that assesses for symptomatology associated with ASD.29”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] Rutter, 2003

      Not checked in the free run.

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

    Study design and conductown data

    The SCQ was translated into Romanian and back-translated.

    “the lifetime SCQ, which had been translated into Romanian and back-translated.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The SCQ manual recommends using a slightly lower threshold in populations with other risk features.

    “The manual also recommends using a slightly lower threshold in populations with other risk features.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Early institutional rearing was associated with an increased risk of social communication difficulties and ASD.

    “Early institutional rearing was associated with an increased risk of social communication difficulties and ASD.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: SCQ scores are comparable across different types of caregivers (institutional caregivers, foster parents, biological parents).
    • Rests on an assumption: The ASD diagnostic evaluation was not biased by knowledge of the child's group assignment.

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

    Premisenone given

    A cutoff score of ≥15 on the SCQ is generally recommended as an indication of possible ASD.

    “a cutoff score of ≥15 is generally recommended as an indication of possible ASD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Early psychosocial deprivation is associated with greater social communication difficulties and an increased incidence of meeting criteria for ASD.

    “The results of this study suggest that early psychosocial deprivation is associated with greater social communication difficulties and an increased incidence of meeting criteria for ASD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    The study's non-interference policy led many children who were initially randomized to the CAUG to later be placed in government-sponsored foster care that did not exist when the study began, or to be reunited with their biological families.

    “the study’s non-interference policy led many children who were initially randomized to the CAUG to later be placed in government-sponsored foster care that did not exist when the study began, or to be reunited with their biological families”
    Quote in the paperSubstantial claim

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

    Study design and conductreasoning

    SCQ scores are based on parent report, so the possibility of observer bias exists.

    “Because SCQ scores are based on parent report, the possibility of observer bias exists (a problem with all parent report measures).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    These results confirm and expand upon previous findings of increased risk for social communication difficulties, restricted/repetitive behaviors, and ASD in children with a history of institutionalization.

    “These results confirm and expand upon previous findings of increased risk for social communication difficulties, restricted/repetitive behaviors, and ASD in children with a history of institutionalization.2, 3, 5, 34, 35”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [2] Rutter, 1999, Quasi-autistic patterns following severe early global privation, J Child Psychol Psychiatry source

      Not checked in the free run.

    • cites [3] Rutter, 2007, Early adolescent outcomes of institutionally deprived and non-deprived adoptees. III. Quasi-autism, J Child Psychol Psychiatry source

      Not checked in the free run.

    • cites [5] Hoksbergen, 2005, Post-institutional autistic syndrome in Romanian adoptees, J Autism Dev Disord source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given

    The process of abandonment itself was not random.

    “the process of abandonment itself was not random.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The true association between ASD and macrocephaly has been called into question recently.

    “the true association between ASD and macrocephaly has been called into question recently).37”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Barnard-Brak, 2011, Macrocephaly in children with autism spectrum disorders, Pediatr Neurol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    High-quality foster care adds to the growing list of developmental domains that are altered in children with a history of institutionalization and can be improved by foster care.

    “this adds to the growing list of developmental domains that are altered in children with a history of institutionalization and can be improved by foster care, including attachment,15, 23, 24 stereotypies,17 language,38–40 cognition,31, 41 depression, anxiety,42, 43 and growth.44”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [15] Smyke, 2012, A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder, Am J Psychiatry source

      Not checked in the free run.

    • cites [17] Bos, 2010, Stereotypies in children with a history of early institutional care, Arch Pediatr Adolesc Med source

      Not checked in the free run.

    • cites [31] Gresham, 1990

      Not checked in the free run.

29 of 29

  • The paper relies on this without support.

    SCQ scores are comparable across different types of caregivers (institutional caregivers, foster parents, biological parents).

    “the caregiver who knew the child best (biological parent, foster parent, adoptive parent or institutional caregiver) filled out the lifetime SCQ”

  • The paper relies on this without support.

    The ASD diagnostic evaluation was not biased by knowledge of the child's group assignment.

    “The second level of evaluation involved an extensive history, physical examination, and structured observations of the child by a Romanian-speaking physician trained in the United States in ASD diagnosis.”

  • The paper relies on this without support.

    In the vast majority of ASD cases, children are raised in caring families, and psychosocial deprivation does not play a significant role.

    “whereas in the vast majority of ASD cases, children are raised in caring families, and psychosocial deprivation does not play a significant role.”
3 of 3

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?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(3, 91) = 4.96reported p = .003 · recomputed p = .003

    “F(3,91) = 4.96, p = .003”

1 of 1

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.

  • ASD group denominators are reversed between the abstract and results

    Major

    The abstract reports 60 CAUG children and 57 FCG children, while the Autism Diagnosis results report 57 CAUG children and 60 FCG children. This changes the group-specific ASD rates.

1 of 1

Cites

Flagged first, then by citations

1 of the 44 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Greenwell, 2006, The impact of child welfare reform on child abandoment and deinstitutionalization, Romania 1990-2000, Ann Demogr Hist (Paris), 1, 133

Cited by

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Related

Authors
Levin, A. R., Fox, N. A., Zeanah, C. H., & Nelson, C. A.
Affiliations
  • Boston Children's Hospital (US)
  • University of Maryland, College Park (US)
  • Tulane University (US)
Corresponding author
Levin, April R.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2015-02
Volume
54
Issue
2
Pages
108-115.e1
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2014.11.011
PMC
PMC4404759
OpenAlex
W1985139407
Semantic Scholar
32443a4fd409c23caa9015dd5abe2f10a305b3bc
Cited by
68
References
44
Citations by year
2025: 4 · 2024: 7 · 2023: 4 · 2022: 9 · 2021: 6 · 2020: 8 · 2019: 9 · 2018: 5 · 2017: 8 · 2016: 4 · 2015: 4
FWCI
14.90
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)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Department of Defense
  • Bill and Melinda Gates Foundation
  • John D. and Catherine T. MacArthur Foundation
  • American Brain Foundation
  • Harvard University
  • Tulane University
  • Binder Family Foundation
  • University of Oxford
  • National Institute of Mental Health (R01MH091363, MH091363)
  • National Institute on Deafness and Other Communication Disorders
  • National Institute of Child Health and Human Development
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (P30HD018655)
Topics
  • Social Sciences › Safety Research › Child Welfare and Adoption
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords
institutional upbringing, social communication deficits, autism spectrum disorder, restricted and repetitive behaviors, foster care, family-centered intervention, Bucharest Early Intervention Project, Social Communication Questionnaire, reciprocal social interaction, early childhood
MeSH terms
Autism Spectrum Disorder, Child, Child Development, Child, Institutionalized, Child, Preschool, Communication, Female, Follow-Up Studies, Foster Home Care, Humans, Infant, Male, Romania, Linear Models, Caregivers, Early Intervention, Educational, Orphanages, Diagnostic and Statistical Manual of Mental Disorders, Social Skills

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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.

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