title: Stereotypies in children with a history of early institutional care.
abstract: OBJECTIVE
  To investigate the prevalence of stereotypies in children with a history of early institutional care, evaluate the efficacy of a foster care intervention compared with institutional care on the course of stereotypies, and describe correlates in language, cognition, and anxiety for children who exhibit stereotypies.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Institutions in Bucharest, Romania.
  
  
  METHODS
  One hundred thirty-six children with a history of early institutional care. Intervention Comparison of a foster care intervention with continued care as usual in an institution.
  
  
  METHODS
  The presence of stereotypies as well as outcomes in language, cognition, and anxiety.
  
  
  RESULTS
  At the baseline assessment prior to placement in foster care (average age of 22 months), more than 60% of children in institutional care exhibited stereotypies. Follow-up assessments at 30 months, 42 months, and 54 months indicated that being placed in families significantly reduced stereotypies, and with earlier and longer placements, reductions became larger. For children in the foster care group, but not in the care as usual group, stereotypies were significantly associated with lower outcomes on measures of language and cognition.
  
  
  CONCLUSIONS
  Stereotypies are prevalent in children with a history of institutional care. A foster care intervention appears to have a beneficial/moderating role on reducing stereotypies, underscoring the need for early placement in home-based care for abandoned children. Children who continue to exhibit stereotypies after foster care placement are significantly more impaired on outcomes of language and cognition than children without stereotypies and thus may be a target for further assessments or interventions.
authors.affiliation: Laboratories of Cognitive Neuroscience, Children's Hospital Boston, 1 Autumn Street, Boston, MA 02115-5365, USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Bos
authors.forename: Charles H
authors.initials: CH
authors.lastname: Zeanah
authors.forename: Anna T
authors.initials: AT
authors.lastname: Smyke
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Fox
authors.forename: Charles A
authors.initials: CA
authors.lastname: Nelson
mesh_terms: D017028:Caregivers / Q000523:psychology; D016009:Chi-Square Distribution; D002657:Child Development; D002669:Child Welfare; D002674:Child, Institutionalized / Q000523:psychology*; D002675:Child, Preschool; D003071:Cognition; D005260:Female; D005581:Foster Home Care; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011610:Psychosocial Deprivation; D019962:Reactive Attachment Disorder; D012383:Romania / Q000453:epidemiology; D018709:Statistics, Nonparametric; D013240:Stereotyping