The DOI matches its Crossref record; 37 of the 38 references it cites were found in a registry or an index; 7 of the 46 sources its claims cite were checked for support.
A Randomized Controlled Trial Comparing Foster Care and Institutional Care for Children With Signs of Reactive Attachment Disorder
Open accessAbstract
OBJECTIVE: The authors examined signs of emotionally withdrawn (inhibited type) and indiscriminately social (disinhibited type) reactive attachment disorder in Romanian children enrolled in a randomized trial of foster care compared with institutional care and in a comparison group of never-institutionalized children. METHOD: At baseline and when children were ages 30, 42, and 54 months and 8 years, caregivers were interviewed with the Disturbances of Attachment Interview to assess changes in signs of reactive attachment disorder in three groups of children: those receiving care as usual (including continued institutional care) (N=68); those placed in foster care after institutional care (N=68); and those who were never institutionalized (N=72). The impact of gender, ethnicity, and baseline cognitive ability was also examined. RESULTS: On the Disturbances of Attachment Interview, signs of the inhibited type of reactive attachment disorder decreased after placement in foster care, and scores were indistinguishable from those of never-institutionalized children after 30 months. Signs of the disinhibited type were highest in the usual care group, lower in the foster care group, and lowest in the never-institutionalized group. Early placement in foster care (before age 24 months) was associated with fewer signs of the disinhibited type. Lower baseline cognitive ability was associated with more signs of the inhibited type in the usual care group and more signs of the disinhibited type in both groups. CONCLUSIONS: Signs of the inhibited type of reactive attachment disorder responded quickly to placement in foster care; signs of the disinhibited type showed less robust resolution with foster placement. Lower baseline cognitive ability was linked to signs of reactive attachment disorder.
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Claims the paper makes
7 of 46 cited sources checked · 2 supported · 0 flagged · accuracy not yet measured
Every source the paper cites for this claim was checked and supports it.
In the paper
“Nevertheless, our confidence in caregiver reports for this sample is high because they converge with observer ratings (29).”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Discussion
What the sources say
- Supportedcites [29] source
The Discussion states that convergence between interviews and observational measures for both types of RAD increased confidence in the caregiver-report measures used. This supports the cited rationale for confidence in caregiver reports. (LLM, conf=0.92)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Results from this investigation have implications not only for young children raised in institutions but also for those who have experienced maltreatment (29, 37, 38) and other forms of neglect.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Discussion
What the sources say
- Partly supportedcites [29] sourceExperimental — accuracy not yet measured
The paper discusses attachment disorders in children who experienced maltreatment, so it provides some context for the proposed implications. But the Discussion (page not provided) says this study examined institutionalization only and its findings may not generalize to children exposed to other adverse caregiving, including other forms of neglect. (LLM, conf=0.84)
- Not checked — no full text of the sourcecites [37] source
- Not checked — no full text of the sourcecites [38] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“scores were indistinguishable from those of never-institutionalized children after 30 months”
- Also stated in: § Discussion · plain
“signs were indistinguishable between children in the foster care group and those in the never-institutionalized group after age 30 months”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Discussion · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“more signs of the disinhibited type in both groups”
- Also stated in: § Factors impacting change in signs of reactive attachment disorder · plain
“children with better cognitive abilities at baseline had fewer signs of this type of reactive attachment disorder across the entire intervention period.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Also stated in: § Factors impacting change in signs of reactive attachment disorder · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Lower baseline cognitive ability was associated with more signs of the inhibited type in the usual care group”
- Also stated in: § Factors impacting change in signs of reactive attachment disorder · plain
“Post hoc comparisons revealed more signs of this type of reactive attachment disorder among children in the usual care group with lower baseline cognitive abilities, across the entire intervention period, compared with children in this group with higher baseline cognitive abilities (t=4.24, df=127, p<.0.001).”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Also stated in: § Factors impacting change in signs of reactive attachment disorder · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Early placement in foster care (before age 24 months) was associated with fewer signs of the disinhibited type.”
- Also stated in: § Timing of intervention · plain
“children placed in foster care before age 24 months had fewer signs of disinhibited reactive attachment disorder at ages 30 months (t=3.11, df=239, p<0.01) and 54 months (t=2.62, df=239, p<0.01) than did those placed after age 24 months.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Timing of intervention · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“signs of the inhibited type of reactive attachment disorder decreased after placement in foster care”
- Also stated in: § Discussion · boosted
“placement of young institutionalized children in quality foster care resulted in marked reduction of signs of inhibited reactive attachment disorder”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Discussion · boosted
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Differences between the foster care group and the never-institutionalized group were evident at baseline and at ages 30 months and 8 years.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Results > Signs of Inhibited Reactive Attachment Disorder
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Post hoc comparisons at ages 30 months (t=4.51, df=475, p<0.001), 42 months (t=4.58, df=475, p<0.001), 54 months (t=4.07, df=475, p<0.001), and 8 years (t=2.70, df=475, p<0.01) all indicated fewer signs of inhibited reactive attachment disorder for children in the foster care group compared with those in the usual care group.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Results > Signs of Inhibited Reactive Attachment Disorder
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“repeated-measures ANOVA revealed a main effect for baseline cognitive ability (F=18.14, df=1, 127, p<0.001), suggesting that children with better cognitive abilities at baseline had fewer signs of this type of reactive attachment disorder across the entire intervention period.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Results > Factors impacting change in signs of reactive attachment disorder
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- Probably not a substantial claim. 14
- It may state two separate claims as one. 22
- The quote only partly states this claim. 1
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Both types of the disorder, emotionally withdrawn (inhibited) and the indiscriminately social (disinhibited), have been described in young children who have been maltreated or raised in conditions of deprivation (2–4).”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
What the sources say
- Partly supportedcites [2] Bowlby J, 1951 sourceExperimental — accuracy not yet measured
The Abstract describes two possible outcomes of early maternal deprivation: an affectionless character or profound emotional and physical apathy. This supports the broader point that deprived young children may show different patterns, but it does not identify them as inhibited and disinhibited RAD, describe indiscriminate sociability, or address maltreatment separately. (LLM, conf=0.82)
- Not checked — no full text of the sourcecites [3] source
- Not checked — no full text of the sourcecites [4] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The association of institutional deprivation and reactive attachment disorder has been noted in the literature since the mid-20th century (1–4).”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
What the sources say
- Not checked — no full text of the sourcecites [1] source
- Partly supportedcites [2] Bowlby J, 1951 sourceExperimental — accuracy not yet measured
The 1952 paper’s Abstract links early deprivation of a mother-figure to impaired emotional development and describes studies of deprived children’s behaviour. It does not specifically identify institutional deprivation or reactive attachment disorder, so it supports the historical connection only at a broader level. (LLM, conf=0.84)
- Not checked — no full text of the sourcecites [3] source
- Not checked — no full text of the sourcecites [4] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The instrument has shown strong convergent (9, 30) and discriminant (29) validity.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Methods > Measures
What the sources say
- Not checked — no full text of the sourcecites [9] source
- Could not verifycites [30] sourceExperimental — accuracy not yet measured
In Part II, ‘PTSD and Secure Base Distortions’ (page unavailable), the paper describes the DAI and reports internal consistency for its secure-base-distortion items and an association between DAI scores and maternal PTSD severity. Neither that passage nor searches for ‘convergent validity’ and ‘discriminant validity’ establish that the DAI has strong validity of either kind. (LLM, conf=0.72)
- Partly supportedcites [29] sourceExperimental — accuracy not yet measured
The Results (page unavailable) examine discriminant validity and find no statistical association between disinhibited RAD and ADHD diagnoses. But the tests concern RAD diagnoses rather than the DAI instrument as a whole; the paper also reports an association between withdrawn RAD signs and depressive symptoms. Its findings therefore do not establish the DAI’s broadly ‘strong’ discriminant validity. (LLM, conf=0.82)
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“When placed with families, children form new attachments (21) and signs of inhibited reactive attachment disorder disappear.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Discussion
What the sources say
- Supportedcites [21] source
The citation is attached to the claim that children placed with families form new attachments, not to the subsequent statement about inhibited reactive attachment disorder. The Discussion says that children placed in foster care after early institutional rearing show recovery in attachment and a strong disposition to form attachments. (LLM, conf=0.92)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All children under age 31 months (N=187) at study initiation (April 2001) who were cared for in the six institutions in Bucharest were assessed for participation in the study.”
- Also stated in: § Sample · plain
“Fifty-one children met exclusion criteria, resulting in an initial study population of 136 children.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Methods > Sample
Strength:plain· not yet calibratedn = 136Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one. The quote only partly states this claim.
- Also stated in: § Sample · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Signs of the disinhibited type were highest in the usual care group, lower in the foster care group, and lowest in the never-institutionalized group.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“One child in the foster care group was subsequently found to meet exclusion criteria and was excluded from further analyses.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Methods > Sample
Strength:plain· not yet calibratedSingle caseTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The repeated-measures analysis showed significant main effects for change over time (F=12.72, df=4, 475, p<0.001) and for group (F=15.42, df=1, 133, p<0.001), but not for the group-by-time interaction, suggesting that scores did not decrease differentially for the usual care and foster care groups (Figure 1).”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Results > Signs of Disinhibited Reactive Attachment Disorder
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Results of repeated-measures ANOVA revealed a baseline cognitive ability-by-group interaction (F=5.89, df=1, 127, p<0.05), indicating a differential effect of baseline cognitive ability on signs of inhibited reactive attachment disorder.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Results > Factors impacting change in signs of reactive attachment disorder
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Preliminary analyses revealed no significant effect of gender or ethnicity and these variables were excluded from further analyses.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“repeated-measures analysis showed a significant interaction of age at placement by time (f=3.39, df=4, 239, p<0.05), indicating that scores decreased differentially for the children placed in foster care before age 24 months compared with those placed after that age.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Results > Timing of intervention
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“By including assessments of reactive attachment disorder prior to removal from institutions and by using well-validated measures administered longitudinally, this randomized controlled trial reduces selection bias and directly addresses questions about the responsiveness of children with reactive attachment disorder to enhanced caregiving.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Third, the comparison groups for two recent studies (11, 15) were Canadian and British children, respectively, rather than ethnically matched children, introducing the possibility that cultural differences may affect outcomes.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
What the sources say
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Children in the study had been abandoned at or soon after birth and placed in institutional care in the custody of the government.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Interest in the effects of institutional care persists to the present day because many children throughout the world are raised in institutions as a result of abuse or neglect, abandonment, or parental incapacity or death (5–7).”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
What the sources say
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did, however, ensure that no child, once placed in foster care through the Bucharest Early Intervention Project, would be returned to an institutional setting, either during or after the study.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Methods > Sample
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Similarly, Rutter and colleagues (4, 14–16) found no signs of the inhibited type of reactive attachment disorder in children adopted before age 4, but a minority of children showed signs of indiscriminate behavior.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
What the sources say
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“For children adopted from institutions, rates of attachment disorders are elevated but lower than those for children living in institutions (11).”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
What the sources say
- Not checked — no full text of the sourcecites [11] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We followed an intent to treat approach in all analyses so that original group assignment was maintained.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Methods > Sample
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“They were assessed comprehensively at baseline and then randomly assigned to care as usual (including continued institutional care) or to placement in foster care, which was created as part of the project.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Since studies of children currently living in institutions have demonstrated that both types of the disorder are readily identifiable (9, 13), the absence of the inhibited type, and the persistence of the disinhibited type in children after they are placed in more favorable caregiving environments are notable.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
What the sources say
Load-bearingStrength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Often, these institutions are large group settings with multiple caregivers whose rotating schedules do not support the development of a focused attachment relationship between a child and a given caregiver (8, 9).”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Of those who had been returned to their parents or been adopted, none exhibited signs of the inhibited type, and a minority continued to exhibit signs of the disinhibited type (13).”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
What the sources say
- Not checked — no full text of the sourcecites [13] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“The Bucharest Early Intervention Project, which was designed as a randomized controlled trial of foster care as an alternative to care as usual among institutionalized young children, addressed many of the limitations of previous studies (17).”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Abstract > Conclusions
What the sources say
- Not checked — no full text of the sourcecites [17] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Each child was given a number (siblings were placed together) and numbers were drawn from a hat and alternately assigned to the two groups.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Methods > Procedure
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The lack of a timing effect suggests that children raised in institutional settings retain a capacity for forming attachments, with no obvious sensitive period.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Discussion
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Two Romanian-speaking research assistants who were trained to reliability on the interview (10) coded each interview. Discrepancies were resolved by conferencing, and a consensus code was obtained for each item.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Methods > Measures
What the sources say
- Not checked — no full text of the sourcecites [10] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The timing of placement in foster care has been shown to have an impact on cognitive recovery for children who experienced institutional care (20)”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Discussion
What the sources say
- Not checked — no full text of the sourcecites [20] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This effect was not evident among children in the foster care group, suggesting that the intervention of foster care was beneficial to children regardless of their cognitive abilities.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“On average, children in the never-institutionalized group were younger at the baseline assessment than children in the study groups (data not shown).”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These findings indicate that placement in families clearly eliminates signs of the inhibited type of reactive attachment disorder, as measured by the Disturbances of Attachment Interview, among young children raised in institutions, but it has a more attenuated effect on the disinhibited type.”
§ A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
Before this study, no planned intervention studies of attachment disorders had been conducted.
“To our knowledge, there have been no previous planned intervention studies of attachment disorders, although some natural experiments have provided valuable data.”
The paper relies on this without support.
No previous studies had examined the impact of the intervention on attachment disorders.
“No previous studies have examined the impact of the intervention on attachment disorders.”
The paper relies on this without support.
No randomized trial comparing foster care and institutional care had been conducted until the BEIP was initiated in 2001.
“Despite 60 years of research comparing young children in foster care and those in institutional care, no randomized trial had been conducted until the Bucharest Early Intervention Project was initiated in 2001.”
The authors state this as an assumption.
The repeated-measures analyses assume data are missing at random.
“repeated-measures analysis of variance (ANOVA; likelihood model, data missing at random, SAS PROC MIXED, two groups and 5 assessments)”
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?
The cited source says what the claim attributes to it.
In the citing paper
“fewer attachment disorder symptoms (Guyon-Harris et al., 2018, 2019;Humphreys et al., 2017;King et al., 2023;Smyke et al., 2012)”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Smyke et al., 2012
The cited source says what the claim attributes to it.
In the citing paper
“Strong improvements in attachment disorder symptoms; moderate improvements in externalizing symptoms and adaptive functioning; weak improvements in internalizing symptoms for boys (strong for girls)”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Smyke et al., 2012
In the citing paper
“To date, investigators have reported that children placed in foster care had significantly fewer symptoms of internalizing disorders, 6 attachment disorders, 21 and stereotyped movement disorders 22 compared to children receiving continued institutional care.”
From Recovering from early deprivation: attachment mediates effects of caregiving on psychopathology (2012) · cites this paper as [21]
In the citing paper
“Externalizing signs, CU traits and attachment disorder behaviors at 12 years all were reduced for children living in foster care [34–37].”
From Alternatives for abandoned children: Insights from the Bucharest Early Intervention Project (2017) · cites this paper as [36]
In the citing paper
“Externalizing signs, CU traits and attachment disorder behaviors at 12 years all were reduced for children living in foster care [34–37].”
From Alternatives for abandoned children: Insights from the Bucharest Early Intervention Project (2017) · cites this paper as [34]
In the citing paper
“At age 12 years, children who had remained in a stable foster placement since original randomization were less likely to display signs of internalizing and externalizing disorders [34]”
From Alternatives for abandoned children: Insights from the Bucharest Early Intervention Project (2017) · cites this paper as [34]
In the citing paper
“Second, there were substantial IQ differences between the groups, with the RAD group showing a lower FSIQ compared with the TD group, which has been reported elsewhere.8,51”
From Ventral striatum dysfunction in children and adolescents with reactive attachment disorder: functional MRI study (2015) · cites this paper as [51]
In the citing paper
“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.”
From Social communication difficulties and autism in previously institutionalized children (2015) · cites this paper as [15]
In the citing paper
“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”
From Social communication difficulties and autism in previously institutionalized children (2015) · cites this paper as [15]
In the citing paper
“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”
From Social communication difficulties and autism in previously institutionalized children (2015) · cites this paper as [15]
In the citing paper
“Studies in this cohort have shown that although multiple areas of development are impaired among ever-institutionalized children, foster care placement leads to improvement in some areas (e.g. cognition,2,3 attachment,5,6,40, language7–9, depression, anxiety,10,12 stereotypies,11 and growth41) but not in other areas”
From Motor outcomes in children exposed to early psychosocial deprivation (2014) · cites this paper as [6]
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.
Claim of lasting similarity conflicts with the eight-year comparison
MajorThe abstract says the foster-care and never-institutionalized groups had indistinguishable inhibited-type scores after 30 months, but the results report a difference between those groups at eight years.
“scores were indistinguishable from those of never-institutionalized children after 30 months.”
“Differences between the foster care group and the never-institutionalized group were evident at baseline and at ages 30 months and 8 years.”
Citations
Cites
Hospitalism; an inquiry into the genesis of psychiatric conditions in early childhood.
Spitz, R. A. (1945) · PubMed · Cited by 1,563
Hospitalism: An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood
Spitz, R. A. (1945) · The Psychoanalytic Study of the Child · doi:10.1080/00797308.1945.11823126 · Cited by 1,476
Maternal Care and Mental Health
(1952) · Archives of Disease in Childhood · doi:10.1136/adc.27.132.205 · Cited by 1,233
Maternal Care and Mental Health
Simon, K., & Bowlby, J. (1951) · The Milbank Memorial Fund Quarterly · doi:10.2307/3348276 · Cited by 1,200
Cognitive Recovery in Socially Deprived Young Children: The Bucharest Early Intervention Project
Nelson, C. A., Zeanah, C. H., Fox, N. A., Marshall, P. J., Smyke, A. T., & Guthrie, D. (2007) · Science · doi:10.1126/science.1143921 · Cited by 951
Self-citationChisholm, K. (1998) · Child Development · doi:10.1111/j.1467-8624.1998.tb06162.x · Cited by 571
Attachment in institutionalized and community children in Romania.
Zeanah, C. H., Smyke, A. T., Koga, S. F., Carlson, E., & The Bucharest Early Intervention Project Core Group (2005) · Child Development · doi:10.1111/j.1467-8624.2005.00894.x · Cited by 516 · cited 3×
“Baseline comprehensive evaluations (20, 24), which included assessments for signs of reactive attachment disorder, were completed (10).”
BackgroundSelf-citationO'CONNOR, T. G., & RUTTER, M. (2000) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200006000-00008 · Cited by 482
ZEANAH, C. H., NELSON, C. A., FOX, N. A., SMYKE, A. T., MARSHALL, P., PARKER, S. W., & KOGA, S. (2003) · Development and Psychopathology · doi:10.1017/s0954579403000452 · Cited by 447 · cited 2×
“Study subjects were three groups of young Romanian children enrolled in the Bucharest Early Intervention Project and repeatedly assessed over time; assessments were conducted at baseline (6–30 months) and at ages 30, 42, and 54 months and 8 years (17, 20).”
BackgroundMethodSelf-citationInstitutional rearing and psychiatric disorders in Romanian preschool children
Zeanah, C. H., Egger, H. L., Smyke, A. T., Nelson, C. A., Fox, N. A., Marshall, P. J., & Guthrie, D. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.08091438 · Cited by 365
Self-citation
Flagged first, then by citations
1 of the 38 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- Bakermans-Kranenburg MJ, 2011, Int J Behav Dev, 36, 1
- 10.1002/(SICI)1097-0355(199921)20:1<42::AID-IMHJ4>3.0.CO;2-B · DOI · Paper page
Cited by
Sorted by citations
Items 101–102 of 102
Lurie, L. A., Gruhn, M. A., Garrisi, K., McLaughlin, K. A., Humphreys, K. L., Zeanah, C. H., Fox, N. A., Nelson, C. A., & Sheridan, M. A. (2025) · Developmental Science · doi:10.1111/desc.70043 · Cited by 2
Self-citationHolt-Gosselin, B., Adri, F., Humphreys, K. L., & Nelson, C. A. (2026) · Development and Psychopathology · doi:10.1017/s0954579426101837
“…et al., 2012; Smyke et al., 2010), fewer attachment disorder symptoms (Guyon-Harris et al., 2018, 2019; Humphreys et al., 2017; King et al., 2023; Smyke et al., 2012), as well as improved peer relationships, social functioning (Almas et al., 2015; Humphreys et al., 2018; Levin et al., 2015; Wade…”
Self-citation
Metadata
- Authors
- Smyke, A. T., Zeanah, C. H., Gleason, M. M., Drury, S. S., Fox, N. A., Nelson, C. A., & Guthrie, D.
- Affiliations
- Tulane University (US)
- Venue
- American Journal of Psychiatry
- Published
- 2012-05
- Volume
- 169
- Issue
- 5
- Pages
- 508-514
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC4158103
- OpenAlex
- W2096000669
- Cited by
- 181
- References
- 38
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 10 · 2023: 8 · 2022: 11 · 2021: 11 · 2020: 13 · 2019: 14 · 2018: 20 · 2017: 18 · 2016: 14 · 2015: 15 · 2014: 13 · 2013: 8 · 2012: 6
- FWCI
- 34.91
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH091363)
- Topics
- Social Sciences › Sociology and Political Science › Child Welfare and Adoption
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- reactive attachment disorder, foster care, institutional care, Romanian orphans
- MeSH terms
- Child, Child, Preschool, Female, Foster Home Care, Humans, Institutionalization, Interview, Psychological, Male, Neuropsychological Tests, Romania, Reactive Attachment Disorder, Early Diagnosis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-09-29, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-09-29 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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