Research articleTemperamental sensitivity to early maltreatment and later family cohesion for externalizing behaviors in youth adopted from foster care
Introduction
Children with a history of foster care are at heightened risk for numerous socio-emotional and behavioral difficulties, especially youth externalizing behavior (EB) (e.g., aggression, delinquency) and related adult outcomes (e.g., substance problems) (Cutuli et al., 2016, Leve et al., 2012, Vidal et al., 2017). Compared to the general population, male and female former foster youth are 4 and 13 times more likely, respectively, to be arrested for EB by the age of 21 years (Courtney et al., 2007), an alarming pattern given that EB itself predicts chronic criminality, substance use disorders, academic failure, and job/economic instability (Edwards, Gardner, Hickman, & Kendler, 2016; Odgers et al., 2008). As a result, EB also contributes to substantial annual societal costs through law enforcement and juvenile justice systems, prisons, rehabilitation programs, and hospitalizations (Welsh et al., 2008).
Although foster youth face significantly higher risk for EB across multiple stages of development, the specific developmental pathways that lead to these long-term outcomes are not well understood. Efforts to identify targets for intervention are complicated by the fact that foster youth often have histories characterized by significant stress (e.g., maltreatment) that can have enduring effects on behavioral development. For example, adoption is conceptualized as a critical intervention for children in foster care, with meta-analytic evidence that adopted children can display significant plasticity in their behavioral outcomes and “catch up” to the general population (van IJzendoorn & Juffer, 2006). However, children also exhibit significant individual differences in responsiveness to these environmental changes (Palacios & Brodzinsky, 2010). Variations in the protective effects of adoption may be influenced by biologically-based traits, such as early temperament, that influence how children perceive and respond to their social environment, as well as by the quality of parenting and family environment in the adoptive home. Understanding the developmental course of EB in children adopted from foster care and identifying which pre- and post-adoption factors (including individual and environmental factors) predict these outcomes across development is critical to designing targeted prevention and intervention programs that are delivered during key developmental periods.
Among the many risk factors foster children experience before adoption, one of the most pervasive is maltreatment, including prenatal substance exposure and postnatal maltreatment such as physical and sexual abuse and/or neglect (Oswald, Heil, & Goldbeck, 2010). There are relatively few longitudinal studies of foster care youth, but postnatal maltreatment is a key predictor of sustained EB over time (Simmel, 2007). Because maltreatment diverges sharply from the average expected environment, it is conceptualized as one of the most toxic and severe environmental conditions for development (Rogosch, Oshri, & Cicchetti, 2010). Childhood maltreatment initiates cascades of atypical development of neurobiological and physiological processes (e.g., HPA-axis functioning, amygdala functional connectivity), emotion regulation, and the formation of attachment and healthy relationships (Cicchetti and Banny, 2014, Rogosch et al., 2010). These effects can further differ based on subtypes of maltreatment (Kuhlman, Geiss, Vargas, & Lopez-Duran, 2015), ranging from physical and sexual abuse, to neglect and exposure to family violence (e.g., witnessing domestic violence between caregivers or sibling abuse). Together, childhood maltreatment and EB exert substantial individual, family, and societal consequences, and they contribute to the intergenerational continuity of psychopathology.
Despite evidence that maltreatment disrupts development across multiple levels of functioning, not all children with maltreatment histories exhibit EB, highlighting the need to identify individual and environmental factors that promote resilience (Haskett, Nears, Ward, & McPherson, 2006). Although rarely examined in the foster care population per se, developmental psychopathology studies more broadly have identified several biologically-based “vulnerability factors,” including temperament traits, that may differentiate children most sensitive versus “resistant” to adversity. Following a diathesis-stress conceptualization of psychopathology, children exposed to maltreatment or early harsh parenting who also had “difficult” or reactive temperaments (e.g., high negative emotionality, high sensitivity, low frustration tolerance, low inhibition) were particularly at risk for developing EB and other psychopathology (Kiff, Lengua, & Zalewski, 2011). That is, temperament acutely increased children's vulnerability to negative environments through Temperament x Environment interactions (Belsky, Hsieh, & Crnic, 1998).
Beyond sensitivity to early stress, emerging studies measuring a full range of caregiving environments have found that compared to children with easy temperaments, children with reactive early temperaments may also benefit more from positive parenting practices (Kochanska & Kim, 2013). That is, according to differential susceptibility theory, children with reactive temperaments may be more sensitive to the environment, for better and for worse (Ellis, Boyce, Belsky, Bakermans-Kranenburg, & van IJzendoorn, 2011). A growing literature consisting of cross-sectional, longitudinal, and emerging experimental studies support the plausibility that reactive temperament may confer general heightened sensitivity to the social environment (Belsky & Pluess, 2009). For example, a randomized controlled trial of infant-mother dyads found that highly irritable/reactive infants, who are traditionally considered at risk for later EB, benefited more from a brief intervention designed to increase secure attachments compared to less irritable infants (Cassidy, Woodhouse, Sherman, Stupica, & Lejuez, 2011). Although intervention studies examining patterns of temperamental sensitivity to the environment are only just emerging, these preliminary studies suggest that compared to children with easy temperaments, children with temperamental risk for EB may also show heightened environmental sensitivity to socially-based interventions.
Although almost no studies of foster youth have investigated patterns of temperamental sensitivity to the environment in the context of differential susceptibility, the implications of this hypothesis for children in foster care are significant: there are over 400,000 children in foster care in the US alone (U.S. Department of Health and Human Services, 2011). Children with complex histories including maltreatment, who may present with more severe EB at initial placement, are particularly stigmatized and less likely to be adopted into nurturing permanent homes (Leathers, Spielfogel, Gleeson, & Rolock, 2012). However, differential susceptibility suggests that these same children more biologically vulnerable to maltreatment may also benefit the most from placement in a nurturing adoptive home, and perhaps even fare better than youth who appeared resilient to early adversity.
Importantly, in attempting to extend the implications of differential susceptibility to high-risk samples with complex histories (e.g., foster-adoptive youth), several key developmental considerations must be considered. First, because early development represents a sensitive period for brain and behavior plasticity (Knudsen, 2004), most differential susceptibility studies have focused on children in infancy and toddlerhood (Hentges, Davies, & Cicchetti, 2015; Leerkes, Nayena Blankson, & O’Brien, 2009). Thus, it is unclear if temperamental sensitivity to the environment extends beyond early childhood to influence youth adopted in later childhood or even adolescence. For example, infant negative emotionality moderated the association between child-care quality and later adolescent EB, but the pattern of interaction was consistent with diathesis stress rather than differential susceptibility (Belsky & Pluess, 2012), suggesting that the effects of positive environments on temperamentally sensitive individuals may fade across development. In contrast, temperamental sensitivity to early maltreatment may continue to negatively influence EB in adolescence (Rioux et al., 2016).
Indeed, because most differential susceptibility studies are cross-sectional, it is unclear how early Temperament x Environment interactions may influence later sensitivity to environmental changes. This is important, because many children at highest risk for EB have already been exposed to maltreatment by the time interventions are implemented, and thus they also exhibit the most severe initial EB. Severe initial EB is linked to treatment resistance (Masi et al., 2011), which suggests that children most sensitive to early maltreatment (and thus with most severe initial EB) may not benefit the most from later intervention. When development is adequately considered, it is unclear whether differential susceptibility applies to children already exhibiting severe EB due to their vulnerability to early adversity. Furthermore, due to the naturalistic design of most EB studies, the source of maltreatment (i.e., caregivers) often continues to be present in the child's environment, making it difficult to distinguish between long-term effects from early adversity versus effects from concurrent adversity. Thus, studies employing experimental or quasi-experimental designs that explicitly measure changes in environmental experiences are poised to clarify developmentally-sensitive aspects of differential susceptibility (van IJzendoorn & Bakermans-Kranenburg, 2012).
In a high-risk sample of children removed from their biological parents and adopted from foster care, the present study had two primary goals: First, we investigated the impact of early maltreatment (i.e., physical abuse, sexual abuse, neglect, exposure to family violence) on EB development for children removed from maltreating environments and placed into adoptive homes. Given that this model has been rarely examined longitudinally and across multiple stages of development for foster-adoptive youth, we tested how subtypes of maltreatment predict children's levels of EB at initial placement into adoptive homes, patterns of EB change across the first five years post-adoption, and long-term EB outcomes in adolescence/young adulthood.
The second primary goal was to explore the role of reactive temperament (e.g., negative emotionality) on these processes in the context of emerging environmental sensitivity theories. In doing so, we explored the following research questions: (1) Does reactive temperament represent a vulnerability factor for pre-placement risk (history of abuse or neglect) on EB levels at initial adoptive placement? (2) Do these same temperament traits pose as sensitivity factors for post-placement adoptive family support to predict decreases in later EB across the first five years of placement? And (3) beyond childhood outcomes, how might these Temperament x Environment patterns change across time with respect to long-term EB outcomes such as arrest history and substance use? By employing a study design that manipulated the environment through adoption as an intervention, this study aimed to provide preliminary evidence to evaluate whether, as proposed by the differential susceptibility theory, youth with reactive temperaments are at once more vulnerable to early maltreatment as well as benefit the most from measurable differences in adoptive family enrichment.
Section snippets
Participants
Between 1996 and 2001, families of 82 children were recruited from the UCLA TIES for Adoption program (now TIES for Families) to participate in a longitudinal study. TIES for Adoption aimed to facilitate successful adoption of high-risk children transitioning from foster care to adoption. Based on requirements from the Adoptions Division of the Los Angeles County Department of Child and Family Services (DCFS), prospective adoptive parents attended a series of educational seminars prior to being
Preliminary analyses
Preliminary bivariate correlations showed that baseline EB was significantly (p < 0.05) and positively correlated with EB across the first four years post-adoption (r = 0.65–0.75) as well as with arrest history (r = 0.37) and substance use (r = 0.32) 11–15 years later. As expected, early reactive temperament was significantly and positively correlated with EB at baseline (r = 0.65), at the first three years post-placement (r = 0.46–0.52), and with EB outcomes at the long-term follow-up (arrest history: r =
Discussion
In a high-risk longitudinal sample of children adopted from foster care, we examined prospective predictions of EB across development from preadoption maltreatment and early reactive temperament; we also explored whether temperament moderated predictions of EB from early maltreatment and later adoptive family support. See Fig. 1 for a conceptual diagram summarizing the primary findings across time points. First, controlling for age, gender, race-ethnicity, and reactive temperament, maltreatment
Acknowledgements
This research was partially supported by a National Science Foundation Graduate Research Fellowship awarded to Irene Tung; no direct support was received from the National Science Foundation for this study's design, data analysis and interpretation, or writing of the report. Special acknowledgement is due to Austin Blake and our research staff for their work in data collection and study coordination, and we are indebted to the children and families who participated in our research study.
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