title: A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder.
abstract: 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  The authors examined signs of emotionally withdrawn (inhibited type) and indiscriminately social (disinhibited type) reactive attachment disorder in Romanian children enrolled in a randomized trial of foster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.
  
  
  METHODS
  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.
authors: Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA. asmyke@tulane.edu
authors: Anna T
authors: AT
authors: Smyke
authors: Charles H
authors: CH
authors: Zeanah
authors: Mary Margaret
authors: MM
authors: Gleason
authors: Stacy S
authors: SS
authors: Drury
authors: Nathan A
authors: NA
authors: Fox
authors: Charles A
authors: CA
authors: Nelson
authors: Donald
authors: D
authors: Guthrie
mesh_terms: D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D005581:Foster Home Care; D006801:Humans; D007326:Institutionalization; D007406:Interview, Psychological; D008297:Male; D009483:Neuropsychological Tests; D019962:Reactive Attachment Disorder / Q000523:psychology / Q000628:therapy*; D012383:Romania