The Scientific Basis for Family-Based Care

2. Presentation to The Way Forward Project February 10, 2011 Mary Dozier The Scientific Basis for Family-Based Care

3. Babies and Young Children • Biologically prepared to depend on caregivers

4. Infant reliance on parent • Temperature regulation • Neuroendocrine regulation • Protection from infection • Protection from danger • Contact comfort • Security

5. Attachment as evolutionarily based system When child is capable of moving away, important that there is a system in place than ensures that he or she stays close under conditions of threat

6. Development of attachment is “canalized” • Child will develop attachment under almost all conditions • Regardless of whether: • Parent is insensitive • Parent is mother, father, grandparent, unrelated • Parent maltreats child • Robust system

7. Having one’s own parent • Likely an “experience expectant” condition • Not something that was expected to vary for different members of the species • Human infants rarely survived if they did not have parent (surrogate parent) who took care of them • So, did not have to be equipped to deal with lack of parental care

8. As the result of how evolution has occurred, human infants are dependent on parents for a number of things • If child does not have parent, it’s not just attachment that is thrown off, but development more generally • Relationship serves to support physiological development, cognitive development, social development

9. Why institutional care is problematic • Child does not have own parent (or surrogate parent) • Staff work shifts (e.g., work 8-12 hours, then others come on) • High child to caregiver ratio (have little time for individual children) • Staff rather than parents (think of this as job)

10. Why institutional care is problematic • Babies “designed” to have someone who is there for them: someone committed • they’re “designed” to deal with caregivers who differ, but not designed for staff (changing caregivers, shifts, etc.)

11. Young children in institutional care Lack stimulation Lack co-regulator Lack attachment figure

12. Institutional care adversely affects: • Attachment • Physical growth • Intellectual development • Attention • Physiological regulation • Quasi-autistic symptoms

13. Attachment • 3 issues: • Does child form attachment? • Does child develop secure and/or organized attachment? • Does child show indiscriminately friendly behavior toward strangers?

14. Development of attachment is “canalized” • Child will develop attachment under almost all conditions • Does not always occur among children in institutions

15. Does child form attachment? • Zeanah, Smyke, Nelson, Fox, et al. (2005) studied attachment behaviors among children in institutions and among children who had been raised in families • Rated children regarding how clear attachment behavior on 5 point scale: • 1: No evidence of attachment behavior • 3: Fragmented sequences of attachment behavior • 5: Clear, classifiable attachment

16. Percentage of children in families and in institutions rated as having clear, classifiable attachments Percentage of children with clear attachments Zeanah et al., 2005

17. Attachment • 3 issues: • Does child form attachment? • Virtually all children in family based care form attachments; • Few children in institutions show clear, classifiable attachments

18. Attachment • 3 issues: • Does child form attachment? • Does child form organized attachment? • Does child show intimate behavior toward strangers?

19. Attachment quality • Organized attachment: has strategy for maintaining maximal proximity to parent • Secure: can go to parent when distressed and get whatever comfort needed • Insecure: may not go to parent, or may go and not be easily soothed, but has a strategy • Disorganized: breakdown in strategy

20. Attachment quality • Secure: can go to parent when distressed and get whatever comfort needed • Insecure: may not go to parent, or may go and not be easily soothed, but has a strategy • Disorganized: breakdown in strategy

21. Disorganized attachment • Associated with problematic outcomes • Most especially, externalizing behavior (getting in trouble) • Meta-analysis of Fearon et al. (2010)

22. Percentage of children in families and in institutions rated as having clear, classifiable attachments Percentage Zeanah et al., 2005

23. Attachment • 3 issues: • Does child form attachment? • Does child form organized attachment? • Does child show intimate behavior toward strangers?

24. Indiscriminate Sociability Child shows behavior toward stranger typically reserved for primary caregiver

25. Percentage of children in families and in institutions rated as showing indiscriminate sociability Percentage Zeanah et al., 2005; O’Connor et al., 2000

26. Physical growth • Significant stunting of growth • Height • Head circumference • Johnson et al. (1994) • Smyke, Nelson, et al. (2007) Photo from UM International Adoption Clinic, Johnson et al.

27. Intellectual development • Lower IQ • Population mean = 100 • Rutter and colleagues (Beckett et al., 2002) found mean IQ of 50 among children in Romanian orphanages • van IJzendoorn et al. (2008) meta-analysis mean of 20 points lower than other children

28. Mean IQ score for family-raised children and for children in orphanage Mean score

29. Intellectual development • Lower alpha power/higher theta power – consistent with less cortical maturation (Marshall, Fox, Zeanah et al., 2004; 2010)

30. Intellectual development • Lower alpha power/higher theta power – consistent with less cortical maturation • Marshall, Fox, Nelson, et al., 2004, 2010 • Particular problems with attention • Gunnar et al., 2000 • Nelson et al., 2009 • Rutter et al., 2010

31. Family-based care • Bucharest Early Intervention Project (Nelson, Fox, Zeanah, et al.) • Random assignment of children to family-based or continued orphanage care • Reversal of many deficits • Van IJzendoorn, Juffer et al. meta-analyses • Power of family-based care