Caregiving disruptions affect growth and pubertal development in early adolescence in institutionalized and fostered Romanian children: A randomized clinical trial
Open accessAbstract
Objectives To determine the effects of foster care vs institutional care, as well as disruptions in the caregiving environment on physical development through early adolescence. Study design This was a randomized controlled trial of 114 institutionalized, though otherwise healthy, children from 6 orphanages and 51 never institutionalized control children living in birth families (family care group) in Bucharest, Romania. Children were followed from baseline (21 months, range 5‐31) through age 12 years for caregiving disruptions and growth trajectories and through age 14 years for pubertal development. Results Children randomized to the foster care group showed greater rates of growth in height, weight, and body mass index (BMI) through age 12 years than institutionalized group. Tanner development was delayed in institutionalized group boys compared with foster care group and family care group boys at 12 but not 14 years. There were no differences in Tanner development and age of menarche among foster care group, institutionalized group, and family care group girls at ages 12 and 14 years. More disruptions in caregiving between 30 months and 12 years moderated decreases in growth rates of height in foster care group and weight in foster care group and institutionalized group across age. institutionalized group boys with ≥2 disruptions showed lower Tanner scores at age 12 vs institutionalized group and foster care group boys with <2 disruptions. foster care group girls with ≥2 disruptions had higher Tanner scores at age 14 vs foster care group girls with <2 disruptions. Age of menarche was not affected by caregiving disruptions. Conclusions For children who experienced early institutionalization, stable placement within family care is essential to ensuring the best outcomes for physical developmental. Trial registration clinicaltrials.gov: NCT00747396.
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- Findingown data
The majority of children in both the institutionalized group (94%) and the foster care group (68%) experienced one or more disruptions between 30 months and 12 years.
“The majority of children in both institutionalized group (94%) and foster care group (68%) experienced 1 or more disruptions during this period of time.”
Quote in the paperNot a substantial claim - Findingown data
Children in the foster care group did not show faster head circumference growth through age 12 than children in the institutionalized group.
“Our present findings indicate that foster care group experienced greater rates of growth in height, weight, and BMI, but not head circumference through age 12 years compared with institutionalized group.”
Quote in the paperSubstantial claim - Findingown data
Mean ages of menarche were similar among the institutionalized, foster care, and family care groups.
“Mean ages of menarche were similar among the 3 groups; institutionalized group 12.2 years (n = 19, CI 11.8, 12.6), foster care group 11.9 years (n = 21, CI 11.5, 12.3), and family care group 12.2 years (n = 25, CI 11.8, 12.5) (F(,61) = 0.674, P = .513, ηp2 =.022).”
Quote in the paperNot a substantial claim - Findingown data
At age 12 years, the foster care group had greater mean weight than the institutionalized group.
“In terms of stature and weight at age 12 years, foster care group (n = 54) exceeded institutionalized group (n = 53) in mean height (156.1 cm, CI 153.7, 158.5 vs 152.6 cm, CI 150.5, 154.6) and mean weight (47.5 kg, CI 44.7, 50.3 vs43.0 kg, CI 40.9, 45.1), P <.05.”
Quote in the paperSubstantial claim- Rests on an assumption: The institutionalized and foster care groups came from similar backgrounds and had comparable adverse experiences during early institutional care.
- Findingown data
Foster care group boys and family care group boys had comparable Tanner scores at age 12 years.
“Foster care group and family care group boys had comparable Tanner scores (mean differences = 0.00; CI −.57, .56).”
Quote in the paperSubstantial claim
- Findingown data
Children assigned to foster care had a faster rate of growth in BMI from baseline through age 12 years than those assigned to continued institutional care.
“Likewise, for BMI z scores, foster care group showed a faster rate of linear increase and a slower rate of deceleration (linear slope: b = .25, CI = .09, .41; quadratic slope: b = −.015, CI −.03, −.004).”
- Also stated in: § Results · plain
“Children randomized to the foster care group showed greater rates of growth in height, weight, and body mass index (BMI) through age 12 years than institutionalized group.”
Quote in the paperSubstantial claim- Rests on an assumption: The institutionalized and foster care groups came from similar backgrounds and had comparable adverse experiences during early institutional care.
- Also stated in: § Results · plain
- Findingown data
There were no group differences in age of menarche among foster care and institutionalized groups with different levels of disruption.
“There were no group differences in the age of menarche among foster care group and institutionalized group with different levels of disruption, F(3,33) = .48, P = .69, ηp2 = .04.”
Quote in the paperNot a substantial claim - Findingown data
Mean Tanner scores differed among boys at age 12 years.
“Mean Tanner scores were different among boys at age 12, F(2,62) = 9.41, P < .001, ηp2 = .23.”
Quote in the paperSubstantial claim - Findingown data
Children assigned to foster care had a faster rate of growth in height from baseline through age 12 years than those assigned to continued institutional care.
“For height z scores, foster care group showed faster rate of linear increase (b = .63, CI .27,.98), a slower rate of deceleration (b = −.08, CI −.14, −.03) and steeper cubic slope (b = .003, CI .001, .006).”
- Also stated in: § Results · plain
“Children randomized to the foster care group showed greater rates of growth in height, weight, and body mass index (BMI) through age 12 years than institutionalized group.”
Quote in the paperSubstantial claim- Rests on an assumption: The institutionalized and foster care groups came from similar backgrounds and had comparable adverse experiences during early institutional care.
- Also stated in: § Results · plain
- Findingown data
Within the institutionalized group, the number of disruptions did not affect the rate of change in height across age.
“In contrast, within institutionalized group, the number of disruptions did not influence the rate of change in height across age (linear slope: b = −.10, CI −.67, .48; quadratic slope: b = .004, CI −.08, .09; cubic slope: b = .004, CI −.004, .004).”
Quote in the paperSubstantial claim - Findingown data
Of the 81 girls who participated in the puberty surveys, 65 (80%) reported age of menarche by age 14 years.
“Of the 81 girls who participated in the puberty surveys, 65 (80%) reported age of menarche by age 14 years, Figure 5 (available at www.jpeds.com).”
Quote in the paperNot a substantial claim - Findingown data
There was a three-way interaction among group, number of disruptions from 30 months to 12 years, and age for height z-scores.
“There was a 3-way interaction among group × number of disruptions from 30 months to 12 years × age, b = −.39 (CI −.74, −.04) (Figure 3).”
Quote in the paperSubstantial claim - Findingown data
Institutionalized group boys had lower Tanner scores at age 12 years than foster care group boys and family care group boys.
“Institutionalized group boys showed lower Tanner scores compared with foster care group (mean difference = −1.00; CI −1.57, −.46) and family care group (mean difference = −1.00; CI −1.54, −.49) boys.”
Quote in the paperSubstantial claim- Rests on an assumption: The institutionalized and foster care groups came from similar backgrounds and had comparable adverse experiences during early institutional care.
- Findingown data
At age 14 years, there were no differences among boys in Tanner stages.
“At age 14 years, there were no difference among boys in Tanner stages, F(2,62) = 1.31, P = .28 ηp2 = .04.”
Quote in the paperNot a substantial claim - Findingown data
Foster care group girls with two or more disruptions had higher Tanner scores at age 14 years than foster care group girls with fewer than two disruptions.
“foster care group girls with ≥2 disruptions had higher Tanner scores at age 14 years compared with foster care group girls with <2 disruptions (mean difference = 1.08; CI .29, 2.01) (Figure 6).”
Quote in the paperSubstantial claim - Findingown data
At age 12 years, children reporting full entry into puberty (combined Tanner score ≥4) had greater height and weight z-scores, with mean differences of 0.68 for height and 0.44 for weight.
“Height and weight were greater in subjects (n = 148) reporting full entry into puberty (combined Tanner score ≥4) with mean differences in z scores of 0.68, (CI 0.22, 1.15) for height and 0.44 (CI .003, 0.87) for weight.”
Quote in the paperNot a substantial claim - Findingown data
Children assigned to foster care had a faster rate of growth in weight from baseline through age 12 years than those assigned to continued institutional care.
“For weight z scores, foster care group showed faster rate of linear increase and slower deceleration (linear slope: b = .31, CI .16, .45; quadratic slope: b = −.02, CI = −.03 to −.01).”
- Also stated in: § Results · plain
“Children randomized to the foster care group showed greater rates of growth in height, weight, and body mass index (BMI) through age 12 years than institutionalized group.”
Quote in the paperSubstantial claim- Rests on an assumption: The institutionalized and foster care groups came from similar backgrounds and had comparable adverse experiences during early institutional care.
- Also stated in: § Results · plain
- Findingown data
Institutionalized group boys with two or more disruptions had lower Tanner scores at age 12 years than institutionalized group boys and foster care group boys with fewer than two disruptions.
“Institutionalized group boys with ≥2 disruptions showed lower Tanner scores at age 12 years compared with institutionalized group (mean difference = −.65; CI −1.33, −.02) and foster care group (mean difference = −1.15; CI −1.76, −.48) boys with <2 disruptions Figure 6 (available at www.jpeds.com).”
Quote in the paperSubstantial claim - Findingown data
The institutionalized group experienced more caregiving disruptions from 30 months to 12 years than the foster care group.
“Disruptions from 30 months to 12 years of age were greater in institutionalized group; (2.10, [CI 1.67, 2.52], range 0–6, n = 52) vs foster care group (.96, [CI .61, 1.31], range 0–4, n = 47).”
Quote in the paperNot a substantial claim - Findingown data
No difference between foster care and institutionalized groups was found in the growth rate of head circumference z scores from baseline to age 12 years.
“However, no group difference in the growth rate of head circumference z scores emerged between baseline and age 12 years (linear slope: b = .01, CI .02, .21; quadratic slope: b = −.01, CI −.01, .00).”
Quote in the paperNot a substantial claim- Rests on an assumption: The institutionalized and foster care groups came from similar backgrounds and had comparable adverse experiences during early institutional care.
- Findingown data
Children in the foster care group showed faster growth in height, weight, and BMI through age 12 than children in the institutionalized group.
“Our present findings indicate that foster care group experienced greater rates of growth in height, weight, and BMI, but not head circumference through age 12 years compared with institutionalized group.”
Quote in the paperSubstantial claim - Findingown data
Salivary testosterone levels were positively correlated with mean Tanner stages in both girls and boys.
“Salivary testosterone levels were positively correlated with the mean Tanner stages in both girls (Pearson rho=.282 n = 67, P = .021) and boys (Pearson rho =.381 n = 65, P = .002).”
Quote in the paperNot a substantial claim - Findingown data
At age 12 years, the foster care group had greater mean height than the institutionalized group.
“In terms of stature and weight at age 12 years, foster care group (n = 54) exceeded institutionalized group (n = 53) in mean height (156.1 cm, CI 153.7, 158.5 vs 152.6 cm, CI 150.5, 154.6) and mean weight (47.5 kg, CI 44.7, 50.3 vs43.0 kg, CI 40.9, 45.1), P <.05.”
Quote in the paperSubstantial claim- Rests on an assumption: The institutionalized and foster care groups came from similar backgrounds and had comparable adverse experiences during early institutional care.
- Findingown data
Caregiving disruptions did not moderate the growth rates of BMI and head circumference z scores across age.
“Disruptions in stable caregiving did not moderate growth rates of BMI and head circumference z scores across age.”
Quote in the paperNot a substantial claim - Findingown data
Within the foster care group, each additional disruption was associated with a 0.31-unit decline in the linear slope of height z-scores across age.
“Within foster care group, each additional disruption was associated with a −.31 unit decline (CI −.62, −.01) in the linear slope of height z-scores across age.”
Quote in the paperSubstantial claim - Findingown data
Puberty was not delayed in institutionalized group girls as previously described.
“Neither was puberty delayed in institutionalized group girls as previously described.16”
Quote in the paperSubstantial claim- The authors state this as an assumption: The children in this study and the previously reported adopted or institutionalized children were exposed to similar adverse environments.
- Findingown data
The only pubertal difference noted was that institutionalized group boys had lower Tanner scores at age 12 than both foster care group boys and family care group boys.
“Despite expectations of altered pubertal tempo, the only difference noted was that Tanner scores at age 12 years in institutionalized group boys were lower compared with both foster care group and family care group boys.”
Quote in the paperSubstantial claim - Findingown data
More caregiving disruptions were associated with slower weight growth in the institutionalized group and the foster care group.
“Increasing disruptions in the caregiving environment were related to decreasing rates of growth in height in foster care group and weight in institutionalized group and foster care group, but not BMI or head circumference.”
Quote in the paperSubstantial claim - Findingown data
More caregiving disruptions were not associated with head circumference growth rate.
“Increasing disruptions in the caregiving environment were related to decreasing rates of growth in height in foster care group and weight in institutionalized group and foster care group, but not BMI or head circumference.”
Quote in the paperNot a substantial claim - Findingown data
Foster care group girls with two or more caregiving disruptions had greater mean Tanner scores at age 14 than foster care group girls with fewer than two disruptions.
“Girls in foster care group who experienced ≥2 caregiving disruptions had greater mean Tanner scores at 14 years of age than foster care group girls experiencing <2 caregiving disruptions.”
Quote in the paperSubstantial claim - Findingown data
Tanner development and age of menarche were comparable among girls in the institutionalized, foster care, and family care groups.
“Tanner development and age of menarche were comparable among girls in institutionalized group, foster care group, and family care group.”
Quote in the paperSubstantial claim - Findingown data
Institutionalized group boys with two or more caregiving disruptions had lower mean Tanner scores at age 12 than institutionalized and foster care group boys with fewer than two disruptions.
“Boys in institutionalized group with ≥2 caregiving disruptions had lower mean Tanner scores at 12 years of age vs institutionalized group and foster care group boys with <2 disruptions.”
Quote in the paperSubstantial claim - Findingown data
More caregiving disruptions were not associated with BMI growth rate.
“Increasing disruptions in the caregiving environment were related to decreasing rates of growth in height in foster care group and weight in institutionalized group and foster care group, but not BMI or head circumference.”
Quote in the paperNot a substantial claim - Findingreasoning
Head circumference did not significantly improve in the foster care group between baseline and age 12.
“Despite placement in a more stable, nurturing, and stimulating environment, head circumference, a surrogate for brain size, did not significantly improve in foster care group between baseline and 12 years.”
Quote in the paperSubstantial claim - Findingown data
The earlier Tanner development or menarche seen in the Danish study was not observed in foster care group girls.
“A shift to earlier Tanner development or age of menarche seen in the Danish study41 was not observed in foster care group girls.”
Quote in the paperNot a substantial claim- The authors state this as an assumption: The children in this study and the previously reported adopted or institutionalized children were exposed to similar adverse environments.
- Findingown data
More caregiving disruptions were associated with slower height growth in the foster care group.
“Increasing disruptions in the caregiving environment were related to decreasing rates of growth in height in foster care group and weight in institutionalized group and foster care group, but not BMI or head circumference.”
Quote in the paperSubstantial claim - Premisecitation
Growth failure and changes in the timing and tempo of puberty are linked to later health issues such as obesity, cardiovascular disease, and metabolic syndrome.
“growth failure and alterations in pubertal onset and tempo are associated with later health problems including obesity, cardiovascular disease, and metabolic syndrome.1–9”
Quote in the paperSubstantial claim0 of 9 sources checked- cites [1] de Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr 2016; 12(Suppl 1): 12– 26. 27187907 PMC5084763 source
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Not checked in the free run.
- Interpretationown data
For children who experienced early institutionalization, stable placement within family care is essential to ensuring the best outcomes for physical development.
“For children who experienced early institutionalization, stable placement within family care is essential to ensuring the best outcomes for physical developmental.”
Quote in the paperSubstantial claim- Rests on an assumption: The institutionalized and foster care groups came from similar backgrounds and had comparable adverse experiences during early institutional care.
- Premisecitation
Severe growth failure is a characteristic feature of institutional care in early childhood.
“Profound growth failure is a hallmark of institutional care in early childhood.10–12”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [10] Johnson DE, Gunnar MR. IV. Growth failure in institutionalized children. Monogr Soc Res Child Dev 2011; 76: 92– 126. 25364058 PMC4214390 source
Not checked in the free run.
- cites [11] van Ijzendoorn MH, Bakermans-Kranenburg MJ, Juffer F. Plasticity of growth in height, weight, and head circumference: meta-analytic evidence of massive catch-up after international adoption. J Dev Behav Pediatr 2007; 28: 334– 43. 17700087 source
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- cites [12] van Ijzendoorn MH, Juffer F. The Emanuel Miller Memorial Lecture 2006: adoption as intervention. Meta-analytic evidence for massive catch-up and plasticity in physical, socio-emotional, and cognitive development. J Child Psychol Psychiatry 2006; 47: 1228– 45. 17176378 source
Not checked in the free run.
- Interpretationown data
This finding adds to the number of sex-related differences in response to adversity or the foster care intervention documented in BEIP.
“This finding extends the number of sex-related differences in the response to adversity or the foster care intervention documented in BEIP.42–44”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [42] Humphreys KL, McGoron L, Sheridan MA, McLaughlin KA, Fox NA, Nelson CA 3rd, High-quality foster care mitigates callous-unemotional traits following early deprivation in boys: a Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2015; 54: 977– 83. 26598472 PMC4660264 source
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- cites [43] McGoron L, Gleason MM, Smyke AT, Drury SS, Nelson CA 3rd, Gregas MC, Recovering from early deprivation: attachment mediates effects of caregiving on psychopathology. J Am Acad Child Adolesc Psychiatry 2012; 51: 683– 93. 22721591 PMC4127424 source
Not checked in the free run.
- cites [44] Smyke AT, Zeanah CH, Fox NA, Nelson CA, Guthrie D. Placement in foster care enhances quality of attachment among young institutionalized children. Child Dev 2010; 81: 212– 23. 20331663 PMC4098033 source
Not checked in the free run.
- Interpretationown data
Stable placement within family care for children who experience early adversity is essential to ensure the best outcomes for physical development.
“In conclusion, this study highlights that stable placement within family care for children who experience adversity in early life is essential to ensure the best outcomes for physical development.”
Quote in the paperSubstantial claim- Rests on an assumption: Foster care placement provides a more stable, nurturing, and stimulating environment than institutional care.
- Study design and conductreasoning
The movement of higher risk children to more nurturing environments may moderate or obscure differences in outcomes between the foster care and institutionalized groups.
“Because all analyses we reported are based on the children’s original group assignments, the movement of higher risk children to more nurturing environments may moderate or obscure differences in outcomes between foster care group and institutionalized group.”
Quote in the paperSubstantial claim - Interpretationown data
Tanner development in boys and girls was differentially influenced by caregiving disruptions.
“Tanner development in boys and girls was differentially influenced by caregiving disruptions.”
Quote in the paperSubstantial claim - Premisecitation
Past studies reporting earlier puberty in girls were conducted in intercountry adoptees placed in Western Europe and the United States.
“Past studies reporting earlier puberty in girls were conducted in intercountry adoptees placed in Western Europe and the US.10,17,18”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [10] Johnson DE, Gunnar MR. IV. Growth failure in institutionalized children. Monogr Soc Res Child Dev 2011; 76: 92– 126. 25364058 PMC4214390 source
Not checked in the free run.
- cites [17] Teilmann G, Parent AS, Skakkebaek NE, Bourguignon JP. Precocious puberty in internationally adopted girls. Contemp Endocrinol Series 2007; 443– 59.
Not checked in the free run.
- cites [18] Mason P, Narad C. Long-term growth and puberty concerns in international adoptees. Pediatr Clin North Am 2005; 52: 1351– 68, vii. 16154467 source
Not checked in the free run.
- Premisecitation
These children likely experienced permanent placement in economically stable families within high-resource countries.
“Considering the social and financial requirements that parents must meet to qualify to adopt internationally, these children likely experienced permanent placement in economically stable families within high resource countries.51”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [51] Hellerstedt WL, Madsen NJ, Gunnar MR, Grotevant HD, Lee RM, Johnson DE. The International Adoption Project: population-based surveillance of Minnesota parents who adopted children internationally. Matern Child Health J 2008; 12: 162– 71. 17562147 PMC2398719 source
Not checked in the free run.
- Study design and conductnone given
Many children originally randomized to the institutionalized group later found placement within family care because of decisions by Romanian child protection officials.
“Finally, because of decisions over time by Romanian child protection official, many children originally randomized to institutionalized group found placement within family care.”
Quote in the paperSubstantial claim - Premisecitation
A meta-analysis found that head circumference is the growth parameter least likely to improve among postinternationally adopted children.
“This result is consistent with a meta-analysis that identified head circumference as the growth parameter least likely to improve among postinternationally adopted children.11”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] van Ijzendoorn MH, Bakermans-Kranenburg MJ, Juffer F. Plasticity of growth in height, weight, and head circumference: meta-analytic evidence of massive catch-up after international adoption. J Dev Behav Pediatr 2007; 28: 334– 43. 17700087 source
Not checked in the free run.
- Interpretationreasoning
Because no institutionalized subjects at baseline were younger than 5 months and only 17% were younger than 12 months, a lack of head catch-up growth in the foster care group as a whole could be expected.
“Because none of our institutionalized subjects evaluated at baseline were <5 months of age and only 17% were <12 months, a lack of head catch-up growth in foster care group as a group could be anticipated.”
Quote in the paperSubstantial claim - Study design and conductreasoning
Using a self-administered Tanner assessment tool is a shortcoming of the study.
“First, despite the fact that data on growth and testosterone levels varied in the expected direction with Tanner scores at 12 years of age, a shortcoming is the use of a self-administered Tanner assessment tool.”
Quote in the paperNot a substantial claim - Interpretationown data
The compromised height and weight growth linked to individual differences in caregiver disruptions in the foster care group highlights the importance of a consistent caregiving environment for child well-being.
“Aside from group differences in growth, the compromised height and weight growth patterns linked to individual differences in caregiver disruptions in foster care group underscore the importance of a consistent caregiving environment for child well-being.”
Quote in the paperSubstantial claim- Rests on an assumption: Foster care placement provides a more stable, nurturing, and stimulating environment than institutional care.
- Study design and conductnone given
All analyses reported are based on the children's original group assignments.
“Because all analyses we reported are based on the children’s original group assignments, the movement of higher risk children to more nurturing environments may moderate or obscure differences in outcomes between foster care group and institutionalized group.”
Quote in the paperSubstantial claim - Study design and conductcitation
A cross-sectional survey at two time points limits what can be determined about the onset and pace of puberty, especially when onset and pace differ between boys and girls.
“Even if we assume that Tanner self-evaluation is reliable, there are limitations as to what can be determined from a cross-sectional survey at 2 time points, particularly when the onset and pace of pubertal development is different in boys and girls.50”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [50] Barnes HVV. Physial growth and developmentat during puberty. Med Clin North Am 1975; 59: 1305– 16. 1186345 source
Not checked in the free run.
- The authors state this as an assumption: Tanner self-evaluation is reliable.
- Interpretationown data
A small number of caregiving disruptions within foster care can have significant additional effects on child well-being.
“The current study demonstrates that a small number of caregiving disruptions within foster care, which adults may view as trivial and even routine, can have significant additional effects on child well-being.”
Quote in the paperSubstantial claim- Rests on an assumption: Foster care placement provides a more stable, nurturing, and stimulating environment than institutional care.
- May combine two claims. 19
- Classified as probably not a substantial claim. 29
May combine two claims.
Findingown dataMean caregiving disruptions between 30 months and 12 years were greater in the institutionalized group than in the foster care group, but within each group there were no differences by sex.
“mean caregiving disruptions between 30 months and 12 years were greater in institutionalized group vs foster care group but within each group, there were no differences by sex”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAmong girls, there were no differences in Tanner stages at age 12 years or at age 14 years.
“Among girls, there were no differences in Tanner stages at age 12 years, F(2,76) = 1.97, P = .15, ηp2 = .05, or age 14 years, F(2,62) = .67, P = .51, ηp2 = .02.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFor weight z-scores, there were no significant three-way interactions, but a main effect of number of disruptions showed that each disruption from 30 months to 12 years was associated with a 0.11-unit decline in the linear slope and a slower acceleration of the quadratic slope across age in both groups.
“There were no significant 3-way interactions observed for the growth rate of weight, but a main effect of the number of disruptions emerged, suggesting disruptions had the same effect on weight z scores across foster care group and institutionalized group: Each disruption from 30 months to 12 years was associated with a −.11 unit decline (CI −.16, −.06) in the linear slope of weight z-scores and a”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAmong institutionalized and foster care girls, there was no group difference in Tanner scores at age 12 years by number of disruptions, but there was a group difference at age 14 years.
“For institutionalized group and foster care group girls with varying numbers of disruptions in stable caregiving from 30 months to 12 years of age, no group difference emerged in Tanner scores at age 12 years, F(3,40) = .28, P = .85, ηp2 = .02, but there was a group difference in Tanner scores at age 14 years, F(3,38) = 3.07, P = .04, ηp2 = .22.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAmong institutionalized and foster care boys, there was a group difference in Tanner scores at age 12 years by number of disruptions, but not at age 14 years.
“There was a group difference among the institutionalized group and foster care group boys with different numbers of disruptions in stable caregiving from 30 months to 12 years of age in Tanner scores at age 12 years, F(3,35) = 4.07, P = .014, ηp2 = .26, but not at age 14 years, F(3,37) = .42, P = .74, ηp2 = .03.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Findingown dataThe mean age of placement into foster care was 24.6 months (SD 5.9, range 9-33 months).
“Because the mean age of placement into foster care was 24.6 ± 5.9 months (SD), range 9–33 months, only disruptions between 30 months and 12 years were used in analyses.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe relative risk for early menarche (before age 11) was not greater in the foster care group versus the family care group or in the ever-institutionalized group versus the family care group.
“The relative risk for early menarche (<11 years of age) was not greater in foster care group vs family care group (OR 2.38, CI0.48, 11.7), or the combined group of institutionalized group and foster care group (ever institutionalized) vs family care group (OR 1.56, CI 0.33, 7.44).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe initial unconditional models showed best fit for a cubic growth pattern for height and a quadratic growth pattern for weight, BMI, and head circumference.
“The initial unconditional models demonstrated best fit for a cubic growth pattern for height, and a quadratic growth pattern for weight, BMI, and head circumference.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAltered pubertal development patterns were associated with both the number of caregiving disruptions and the child's sex.
“Furthermore, our findings suggest that altered patterns of pubertal development were linked to both number of caregiving disruptions and the child’s sex.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenAn intent-to-treat approach was followed, with all reported analyses based on the children's original group assignments.
“However, irrespective of changes in the caregiving environment over the duration of the study, an intent-to-treat approach was followed, whereby all analyses we report are based on children’s original group assignments.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductnone givenFull information maximum likelihood estimation was used to handle missing data and obtain unbiased estimates.
“Full information maximum likelihood estimation was used to handle missing data and obtain unbiased estimates.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationKnowledge is limited about how early institutionalization affects pubertal development, with studies reporting delays, accelerations, and no effects on various pubertal markers in boys and girls.
“Less is known about how early institutionalization influences pubertal development with reports of delays,16 accelerations,10,14,17,18 and null15,19 effects on various markers of pubertal development in boys and girls.”
Quote in the paperSubstantial claim0 of 7 sources checked- cites [16] Himes JH, Park K, Iverson S, Mason P, Federici R, Johnson DE. Physical growth and sexual maturation of severely deprived children reared in Romanian orphanages In: Ashizawa K, Cameron N, eds. Human growth in a changing lifestyle. London: Smith-Gordon; 2009 p. 79– 84.
Not checked in the free run.
- cites [10] Johnson DE, Gunnar MR. IV. Growth failure in institutionalized children. Monogr Soc Res Child Dev 2011; 76: 92– 126. 25364058 PMC4214390 source
Not checked in the free run.
- cites [14] Sonuga-Barke EJS, Schlotz W, Rutter M. VII. Physical growth and maturation following early severe institutional deprivation: do they mediate specific psychopathological effects? Monogr Soc Res Child Dev 2010; 75: 143– 66. 20500637 source
Not checked in the free run.
- cites [17] Teilmann G, Parent AS, Skakkebaek NE, Bourguignon JP. Precocious puberty in internationally adopted girls. Contemp Endocrinol Series 2007; 443– 59.
Not checked in the free run.
- cites [18] Mason P, Narad C. Long-term growth and puberty concerns in international adoptees. Pediatr Clin North Am 2005; 52: 1351– 68, vii. 16154467 source
Not checked in the free run.
- cites [15] Reid BM, Miller BS, Dorn LD, Dejardins C, Donzella B, Gunnar M. Early growth faltering in post-institutionalized youth and later anthropometric and pubertal development. Pediatr Res 2017; 82: 278– 84. 28170387 PMC5552432 source
Not checked in the free run.
- cites [19] Hayes P, Tan TX. Timing of menarche in girls adopted from China: a cohort study. Child Care Health Dev 2016; 42: 859– 62. 27545904 source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductcitationAll analyses of pubertal stages adjusted for age at the time of the puberty survey and BMI z-score at age 12 years.
“All analyses examining pubertal stages accounted for age at time of the puberty survey and BMI z-score at age 12 years, given that higher BMI and age are related to later pubertal stages.38,39”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [38] De Leonibus C, Marcovecchio ML, Chiavaroli V, de Giorgis T, Chiarelli F, Mohn A. Timing of puberty and physical growth in obese children: a longitudinal study in boys and girls. Pediatr Obes 2014; 9: 292– 9. 23713062 source
Not checked in the free run.
- cites [39] Tomova A, Robeva R, Kumanov P. Influence of the body weight on the onset and progression of puberty in boys. J Pediatr Endocrinol Metab 2015; 28: 859– 65. 25781529 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe intra-assay and inter-assay coefficients of variance for testosterone were acceptable.
“Intra-assay (2.74%) and inter-assay (11.24%) coefficients of variance were acceptable.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataThere were no significant differences in age by group or sex at either the 12-year or 14-year assessment.
“There were no significant differences in age by group (institutionalized group 12.6, [n = 53, CI 12.5,12.8] and 14.4 [n = 46, CI 14.1,14.6]; foster care group 12.6, [n = 51, CI 12.4,12.7] and14.3, [n = 43, CI 14.1, 14.5]; family care group. 12.7 [n = 50, CI 12.6,12.8] and 14.4 [n = 44, CI 14.2.14.6])”
- Also stated in: § Measures · plain
“or sex (female, 12.6 [n = 81, CI 12.5, 12.8] and 14.3 [n = 67, CI 14.2, 14.5]; male, 12.6 [n = 73, CI 12.5, 12.8] and 14.4 [n = 70, CI 14.2, 14.5]) at either time point.”
Quote in the paperNot a substantial claim- Also stated in: § Measures · plain
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThree longitudinal studies have followed physical growth into late childhood or adolescence.
“3 longitudinal studies have tracked physical growth through late childhood or adolescence.13–15”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [13] Le Mare L, Audet K. A longitudinal study of the physical growth and health of postinstitutionalized Romania adoptees. Paediatr Child Health 2006; 11: 85– 91. 19030260 PMC2435332
Not checked in the free run.
- cites [14] Sonuga-Barke EJS, Schlotz W, Rutter M. VII. Physical growth and maturation following early severe institutional deprivation: do they mediate specific psychopathological effects? Monogr Soc Res Child Dev 2010; 75: 143– 66. 20500637 source
Not checked in the free run.
- cites [15] Reid BM, Miller BS, Dorn LD, Dejardins C, Donzella B, Gunnar M. Early growth faltering in post-institutionalized youth and later anthropometric and pubertal development. Pediatr Res 2017; 82: 278– 84. 28170387 PMC5552432 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 dataBonferroni correction was applied to multiple pairwise comparisons, and 5000 bootstrap resamples were performed to obtain bootstrapped estimates of the mean and 95% confidence intervals.
“Bonferroni correction was applied to multiple pair-wise comparisons; 5000 bootstrap resamples were performed to obtain bootstrapped estimates of the mean and 95% CIs to ensure reliability.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductown dataRandomization was implemented by assigning each child a number written on paper, placing the numbers in a hat, and drawing them at random.
“Randomization was implemented by assigning each child a number (1–136) written on a piece of paper, which were then placed in a hat and then drawn at random.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMany studies have shown short-term catch-up growth when children are moved to more nurturing environments.
“Many studies have documented catch-up growth over the short term in children placed in more nurturing environments,10–12”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [10] Johnson DE, Gunnar MR. IV. Growth failure in institutionalized children. Monogr Soc Res Child Dev 2011; 76: 92– 126. 25364058 PMC4214390 source
Not checked in the free run.
- cites [11] van Ijzendoorn MH, Bakermans-Kranenburg MJ, Juffer F. Plasticity of growth in height, weight, and head circumference: meta-analytic evidence of massive catch-up after international adoption. J Dev Behav Pediatr 2007; 28: 334– 43. 17700087 source
Not checked in the free run.
- cites [12] van Ijzendoorn MH, Juffer F. The Emanuel Miller Memorial Lecture 2006: adoption as intervention. Meta-analytic evidence for massive catch-up and plasticity in physical, socio-emotional, and cognitive development. J Child Psychol Psychiatry 2006; 47: 1228– 45. 17176378 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationIQ differences between groups at age 12 could further bias self-report measures.
“Additional factors in this cohort such as IQ differences between groups at 12 years of age could further bias self-report measures.49”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [49] Almas AN, Degnan KA, Nelson CA, Zeanah CH, Fox NA. IQ at age 12 following a history of institutional care: findings from the Bucharest Early Intervention Project. Dev Psychol 2016; 52: 1858– 66. 27709994 PMC5083169 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationIn a Danish longitudinal study of 276 internationally adopted girls, breast development and menarche curves had shapes similar to typically developing Danish girls but were shifted 1.3 years earlier.
“In a longitudinal study of 276 internationally adopted girls to Denmark, the normal probability curves for breast development and menarche were similar in shape to those of typically developing Danish girls but were displaced 1.3 years earlier for both breast development and menarche.41”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [41] Teilmann G, Petersen JH, Gormsen M, Damgaard K, Skakkebaek NE, Jensen TK. Early puberty in internationally adopted girls: hormonal and clinical markers of puberty in 276 girls examined biannually over two years. Horm Res 2009; 72: 236– 46. 19786795 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataData on growth and testosterone levels varied in the expected direction with Tanner scores at age 12.
“First, despite the fact that data on growth and testosterone levels varied in the expected direction with Tanner scores at 12 years of age, a shortcoming is the use of a self-administered Tanner assessment tool.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSelf-assessment never quite reaches the accuracy of direct examination by trained observers.
“Though considered reliable45,46 and necessary in the current situation because of the vulnerable nature of our sample, self-assessment never quite attains the accuracy of direct examination by trained observers.47,48”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [47] Rasmussen AR, Wohlfahrt-Veje C, Tefre de Renzy-Martin K, Hagen CP, Tinggaard J, Mouritsen A, Validity of self-assessment of pubertal maturation. Pediatrics 2015; 135: 86– 93. 25535262 source
Not checked in the free run.
- cites [48] Desmangles JC, Lappe JM, Lipaczewski G, Haynatzki G. Accuracy of pubertal Tanner staging self-reporting. J Pediatr Endocrinol Metab 2006; 19: 213– 21. 16607921 source
Not checked in the free run.
May combine two claims.
PremisecitationChildren in the institutionalized group did not experience the same quality of family care as the foster care group, nor did they experience the unspeakable conditions endured by the previously reported cohort.
“Although children in institutionalized group did not experience the same quality of family care as foster care group neither did they experience the unspeakable conditions endured by the previously reported cohort.16,52”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [16] Himes JH, Park K, Iverson S, Mason P, Federici R, Johnson DE. Physical growth and sexual maturation of severely deprived children reared in Romanian orphanages In: Ashizawa K, Cameron N, eds. Human growth in a changing lifestyle. London: Smith-Gordon; 2009 p. 79– 84.
Not checked in the free run.
- cites [52] Johnson DE. Medical and developmental sequelae of early childhood institutionalization in Eastern European adoptees In: Nelson CA, ed. The effects of early adversity on neurobehavioral development: the Minnesota Symposia on Child Psychology. Mahwaw (NJ): Lawrence Erlbaum Associates; 2000 p. 113– 62.
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationLate pubertal development was described in children who experienced a lifetime of severe adversity in the worst Romanian orphanages during and immediately after the Ceausescu era.
“Late pubertal development was described in children experiencing a lifetime of severe adversity in the worst Romanian orphanages during and immediately after the Ceausescu era.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [16] Himes JH, Park K, Iverson S, Mason P, Federici R, Johnson DE. Physical growth and sexual maturation of severely deprived children reared in Romanian orphanages In: Ashizawa K, Cameron N, eds. Human growth in a changing lifestyle. London: Smith-Gordon; 2009 p. 79– 84.
Not checked in the free run.
- cites [52] Johnson DE. Medical and developmental sequelae of early childhood institutionalization in Eastern European adoptees In: Nelson CA, ed. The effects of early adversity on neurobehavioral development: the Minnesota Symposia on Child Psychology. Mahwaw (NJ): Lawrence Erlbaum Associates; 2000 p. 113– 62.
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationChildren enter foster care with a sum of adverse childhood experiences.
“Children enter foster care with a sum of adverse childhood experiences.55–57”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [55] Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998; 14: 245– 58. 9635069 source
Not checked in the free run.
- cites [56] Kerker BD, Zhang J, Nadeem E, Stein RE, Hurlburt MS, Heneghan A, Adverse childhood experiences and mental health, chronic medical conditions, and development in young children. Acad Pediatr 2015; 15: 510– 7. 26183001 PMC4562867 source
Not checked in the free run.
- cites [57] Forkey H, Szilagyi M. Foster care and healing from complex childhood trauma. Pediatr Clin North Am 2014; 61: 1059– 72. 25242716 source
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationUnder normal conditions, postnatal brain and head circumference growth velocity is highest just after birth and then falls rapidly during the first year.
“Under normal circumstances, postnatal brain and consequent head circumference growth velocity are greatest immediately after birth then rapidly decrease during the first year of life.40”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [40] Tanner JM. Physical growth and development In: Forfar JO, Arneil GC, eds. Textbook of pediatrics. Edinburgh: Churchill Livingstone; 1978 p. 253– 303.
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe randomized controlled design minimizes but can never exclude the influence of other factors on the results.
“The randomized controlled design of this study minimizes but can never exclude the influence of other factors on our results.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA previous survey found that puberty onset was delayed by about 2.5 years in girls and 1.5 years in boys in Romanian orphanages.
“A previous survey of pubertal development in children experiencing severe deprivation within Romanian orphanages revealed that the onset of puberty was delayed by approximately2.5 years in girls and 1.5 years in boys.16”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [16] Himes JH, Park K, Iverson S, Mason P, Federici R, Johnson DE. Physical growth and sexual maturation of severely deprived children reared in Romanian orphanages In: Ashizawa K, Cameron N, eds. Human growth in a changing lifestyle. London: Smith-Gordon; 2009 p. 79– 84.
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe children in this study were placed in foster care during difficult economic times before Romania joined the European Union in 2007, when nutrition or overall family stress may have been significantly different.
“Conversely, our children were placed in foster care during the difficult economic times preceding Romania’s accession to the European Union in 2007 when nutrition or the level of overall family stress, may have been significantly different.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAn early rise in pituitary and ovarian hormones before external signs of sexual maturation suggested that early pubertal development is centrally driven by early activation of the hypothalamic-pituitary axis.
“In that Danish cohort, an early but otherwise normal rise in pituitary and ovarian hormones that predated external signs of sexual maturation suggested that this early pubertal development is centrally driven through early activation of the hypothalamic-pituitary axis.41”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [41] Teilmann G, Petersen JH, Gormsen M, Damgaard K, Skakkebaek NE, Jensen TK. Early puberty in internationally adopted girls: hormonal and clinical markers of puberty in 276 girls examined biannually over two years. Horm Res 2009; 72: 236– 46. 19786795 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationCaregiving disruptions in the US foster care system are common.
“Unfortunately, caregiving disruptions in the US foster care system are common.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [53] Center KCD In: Foundation AEC, ed. Children in foster care with more than two placements. Annie E Casey Foundation; http://datacenter.kidscount.org/data/tables/8822-children-in-foster-care-with-more-than-two-placements?loc=1&loct=1#detailed/1/any/false/573,869,36,868,867/any/17680,17681. Accessed April 24, 2018.
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationBetween 2011 and 2015, slightly more than one-third of children in foster care experienced two or more placements.
“Between 2011 and 2015 slightly more than one-third of children in foster care experienced ≥2 placements.53”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [53] Center KCD In: Foundation AEC, ed. Children in foster care with more than two placements. Annie E Casey Foundation; http://datacenter.kidscount.org/data/tables/8822-children-in-foster-care-with-more-than-two-placements?loc=1&loct=1#detailed/1/any/false/573,869,36,868,867/any/17680,17681. Accessed April 24, 2018.
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
Study design and conductreasoningTaking into account the presence and magnitude of additional adverse experiences in the three groups is difficult if not impossible.
“Taking into account the presence and magnitude of additional adverse experiences in the 3 groups is difficult if not impossible.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMany studies have reported a higher rate of early pubertal development in children adopted out of adverse environments, especially girls.
“In contrast, in children adopted out of adverse environments such as institutional or foster care, many, though not all studies,15,19 have documented a higher rate of early pubertal development particularly in girls.10,17”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [15] Reid BM, Miller BS, Dorn LD, Dejardins C, Donzella B, Gunnar M. Early growth faltering in post-institutionalized youth and later anthropometric and pubertal development. Pediatr Res 2017; 82: 278– 84. 28170387 PMC5552432 source
Not checked in the free run.
- cites [19] Hayes P, Tan TX. Timing of menarche in girls adopted from China: a cohort study. Child Care Health Dev 2016; 42: 859– 62. 27545904 source
Not checked in the free run.
- cites [10] Johnson DE, Gunnar MR. IV. Growth failure in institutionalized children. Monogr Soc Res Child Dev 2011; 76: 92– 126. 25364058 PMC4214390 source
Not checked in the free run.
May combine two claims.
InterpretationreasoningThe stress of having to accommodate changing care environments alters normal developmental processes and changes outcomes for the worse.
“The stress of having to accommodate changing care environments alters normal developmental processes and changes outcome for the worse.”
Quote in the paperSubstantial claim- Rests on an assumption: Foster care placement provides a more stable, nurturing, and stimulating environment than institutional care.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.
PremisecitationThe current opioid crisis in the US foretells worsening conditions as the number of children entering foster care increases and further strains child welfare systems' ability to provide uninterrupted family-based care.
“The current opioid crisis in the US foretells worsening conditions as the number of children entering foster care increases and further strains the ability of child welfare systems to provide uninterrupted family-based care.54”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [54] Stein P, Bever L. The opioid crisis is straining the nation’s foster-care systems The Washington Post. Washington: WP Company LLC; 7 1, 2017 https://www.washingtonpost.com/national/the-opioid-crisis-is-straining-the-nations-foster-care-systems/2017/06/30/97759fb2-52a1-11e7-91eb-9611861a988f_story.html?utm_term=.6cd236ef2f2f. Accessed April 24, 2018.
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationIn that cohort, 16% entered puberty before age 8 and approximately the same percentage had menarche before age 11.
“Consequently, 16% entered puberty prior to 8 years of age and approximately the same percentage experienced menarche prior to 11 years of age.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [41] Teilmann G, Petersen JH, Gormsen M, Damgaard K, Skakkebaek NE, Jensen TK. Early puberty in internationally adopted girls: hormonal and clinical markers of puberty in 276 girls examined biannually over two years. Horm Res 2009; 72: 236– 46. 19786795 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationEarlier pubertal development has been observed in Romanian children placed in adoptive families in the United Kingdom.
“Earlier pubertal development has also been observed in Romanian children placed in adoptive families in the United Kingdom.14”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [14] Sonuga-Barke EJS, Schlotz W, Rutter M. VII. Physical growth and maturation following early severe institutional deprivation: do they mediate specific psychopathological effects? Monogr Soc Res Child Dev 2010; 75: 143– 66. 20500637 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 conductreasoningAdversity in early life encompasses many domains, and the present study was designed to examine only a limited number of variables that could affect physical development.
“Third, adversity in early life encompasses many domains and the present study was designed to examine only a limited number of variables that could potentially impact physical development.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The institutionalized and foster care groups came from similar backgrounds and had comparable adverse experiences during early institutional care.
“a cohort of children from similar backgrounds who experienced a comparable mix of adverse experiences within institutional care early in life followed either by continued institutional care (institutionalized group) or foster care (foster care group).”
The authors state this as an assumption.
The children in this study and the previously reported adopted or institutionalized children were exposed to similar adverse environments.
“Second, implicit in the assumption that we might observe earlier or later pubertal development was that our subjects and previously reported adopted or institutionalized children experienced similar adverse environments.”
The paper relies on this without support.
Head circumference is a valid surrogate for brain size.
“Despite placement in a more stable, nurturing, and stimulating environment, head circumference, a surrogate for brain size, did not significantly improve in foster care group between baseline and 12 years.”
The authors state this as an assumption.
Tanner self-evaluation is reliable.
“Even if we assume that Tanner self-evaluation is reliable, there are limitations as to what can be determined from a cross-sectional survey at 2 time points, particularly when the onset and pace of pubertal development is different in boys and girls.50”
The paper relies on this without support.
Foster care placement provides a more stable, nurturing, and stimulating environment than institutional care.
“Despite placement in a more stable, nurturing, and stimulating environment, head circumference, a surrogate for brain size, did not significantly improve in foster care group between baseline and 12 years.”
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?
Previous BEIP studies focused on physical health trajectories from infancy to adolescence found that participants randomized to the foster care group experienced greater increases in BMI.
“previous BEIP studies focused on physical health trajectories from infancy to adolescence found that participants randomized to the foster care group (FCG) experienced greater increases in BMI”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Johnson et al., 2018
Statistics that don’t add up
Each reported p-value recomputed from its test statistic and degrees of freedom.
Inconsistent p-value: F(3,40) = .28, p = .85
MinorThe paper reports p = .85 here; recomputing from the test statistic and its degrees of freedom gives p = .840. The check cannot tell whether the statistic or the p-value is the misprint.
Reported p = .85 · recomputed p = .840
“F(3,40) = .28, P = .85”
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.
- Doesn’t add upF(3, 40) = 0.28reported p = .85 · recomputed p = .840
“F(3,40) = .28, p = .85”
- Not confirmedF(3, 33) = 0.48reported p = .69 · recomputed p = .698
“F(3,33) = .48, p = .69”
- ConsistentF(2, 62) = 9.41reported p < .001 · recomputed p < .001
“F(2,62) = 9.41, p < .001”
- ConsistentF(2, 62) = 1.31reported p = .28 · recomputed p = .277
“F(2,62) = 1.31, p = .28”
- ConsistentF(2, 76) = 1.97reported p = .15 · recomputed p = .147
“F(2,76) = 1.97, p = .15”
- ConsistentF(2, 62) = 0.67reported p = .51 · recomputed p = .515
“F(2,62) = .67, p = .51”
- ConsistentF(3, 35) = 4.07reported p = .014 · recomputed p = .014
“F(3,35) = 4.07, p = .014”
- ConsistentF(3, 37) = 0.42reported p = .74 · recomputed p = .740
“F(3,37) = .42, p = .74”
- ConsistentF(3, 38) = 3.07reported p = .04 · recomputed p = .039
“F(3,38) = 3.07, p = .04”
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.
Head-circumference result conflicts with its reported confidence interval
MajorThe paper says there was no group difference in head-circumference growth, but the reported confidence interval for the linear group effect is entirely above zero. The point estimate, .01, also falls outside its stated interval of .02 to .21.
“However, no group difference in the growth rate of head circumference z scores emerged between baseline and age 12 years”
“linear slope: b = .01, CI .02, .21”
Baseline age ranges disagree
MinorThe abstract gives a maximum baseline age of 31 months, whereas the Methods section gives 32 months.
“baseline (21 months, range 5–31)”
“baseline (21.0 ± 7.4 [SD], range 5–32 months)”
Age-14 group and sex counts have different totals
MinorThe three age-14 group counts sum to 133, while the female and male counts for that time point sum to 137. Both breakdowns purport to describe participants at the same assessment.
“14.4 [n = 46, CI 14.1,14.6]; foster care group 12.6, [n = 51, CI 12.4,12.7] and14.3, [n = 43, CI 14.1, 14.5]; family care group. 12.7 [n = 50, CI 12.6,12.8] and 14.4 [n = 44, CI 14.2.14.6]”
“female, 12.6 [n = 81, CI 12.5, 12.8] and 14.3 [n = 67, CI 14.2, 14.5]; male, 12.6 [n = 73, CI 12.5, 12.8] and 14.4 [n = 70, CI 14.2, 14.5]”
Foster-care disruption counts leave one participant unaccounted for
MinorThe disruption analysis reports 47 foster-care participants, but its female and male breakdowns contain only 23 participants each, totaling 46.
“vs foster care group (.96, [CI .61, 1.31], range 0–4, n = 47)”
“foster care group; female subjects (0.78 [CI 0.30, 1.27], range 0–4, n = 23), male subjects (1.13 [CI .61, 1.64], range 0–4, n = 23)”
Cites
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(98)00017-8 · Cited by 18,943 · cited 1× · see citing works
“Randomization was implemented by assigning each child a number (1-136) written on a piece of paper, which were then placed in a hat and then drawn at random.”
Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence
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Child abuse: Adolescent records vs. adult recall
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“…trajectories from infancy to adolescence found that participants randomized to the foster care group (FCG) experienced greater increases in BMI (Johnson et al., 2018; Tang et al., 2018), with distinct trajectories correlated with higher levels of glycosylated hemoglobin (HbA1c) (Tang et al.,…”
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Paniagua, C. T., Sánchez‐Queija, I., Moreno, C., & Rivera, F. (2024) · Journal of Adolescence · doi:10.1002/jad.12351
Institutionalization and Aggressiveness - Gender Differences
Fedor, C.-G. (2023) · Logos Universality Mentality Education Novelty SOCIAL SCIENCES · doi:10.18662/lumenss/12.1/79
Avaliação do desenvolvimento biopsíquico de crianças sob tutela
Araujo, G. A., Salazar, G. C., Julião, K. M., et al. (2023) · Revista Eletrônica Acervo Saúde · doi:10.25248/reas.e11996.2023
Health of Post-Institutionalized Haitian Children Adopted to the United States
George, P. E., Gamble, A. V., Palzer, E. F., Brearley, A. M., Johnson, D. E., & Eckerle, J. K. (2023) · Maternal and Child Health Journal · doi:10.1007/s10995-022-03574-4
Self-citation
- Authors
- Johnson, D. E., Tang, A., Almas, A. N., Degnan, K. A., McLaughlin, K. A., Nelson, C. A., Fox, N. A., Zeanah, C. H., & Drury, S. S.
- Affiliations
- University of Minnesota (US)
- University of Maryland, College Park (US)
- University of British Columbia (CA)
- Catholic University of America (US)
- University of Washington (US)
- Boston Children's Hospital (US)
- Tulane University (US)
- Corresponding author
- Johnson, Dana E.
- ORCID
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 203
- Pages
- 345-353.e3
- ISSN
- 0022-3476 (ISSN-L)
- PMC
- PMC6271564
- OpenAlex
- W2889326638
- Semantic Scholar
- faf8810c51bf9ff1e04af169944f46b54d23b24a
- Cited by
- 49
- References
- 58
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 5 · 2023: 10 · 2022: 2 · 2021: 6 · 2020: 5 · 2019: 8 · 2018: 2
- FWCI
- 10.47
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- John D. and Catherine T. MacArthur Foundation
- Binder Family Foundation
- National Institute of Mental Health (R01MH091363)
- Topics
- Social Sciences › Safety Research › Child Welfare and Adoption
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- foster care, institutional care, orphanages, early adolescence, pubertal development, growth trajectories, height, body mass index, Tanner stages, age at menarche, Romanian orphans, family care
- MeSH terms
- Adolescent, Body Weight, Child, Child Development, Child, Institutionalized, Child, Preschool, Female, Foster Home Care, Humans, Infant, Male, Romania, Body Mass Index, Orphanages
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