title: Adverse childhood experiences, psychosocial well-being and cognitive development among orphans and abandoned children in five low income countries.
abstract: BACKGROUND
  Development policymakers and child-care service providers are committed to improving the educational opportunities of the 153 million orphans worldwide. Nevertheless, the relationship between orphanhood and education outcomes is not well understood. Varying factors associated with differential educational attainment leave policymakers uncertain where to intervene. This study examines the relationship between psychosocial well-being and cognitive development in a cohort of orphans and abandoned children (OAC) relative to non-OAC in five low and middle income countries (LMICs) to understand better what factors are associated with success in learning for these children.
  
  
  METHODS
  Positive Outcomes for Orphans (POFO) is a longitudinal study, following a cohort of single and double OAC in institutional and community-based settings in five LMICs in Southeast Asia and sub-Saharan Africa: Cambodia, Ethiopia, India, Kenya, and Tanzania. Employing two-stage random sampling survey methodology to identify representative samples of OAC in six sites, the POFO study aimed to better understand factors associated with child well-being. Using cross-sectional and child-level fixed effects regression analyses on 1,480 community based OAC and a comparison sample of non-OAC, this manuscript examines associations between emotional difficulties, cognitive development, and a variety of possible co-factors, including potentially traumatic events.
  
  
  RESULTS
  The most salient finding is that increases in emotional difficulties are associated with lags in cognitive development for two separate measures of learning within and across multiple study sites. Exposure to potentially traumatic events, male gender, and lower socio-economic status are associated with more reported emotional difficulties in some sites. Being female and having an illiterate caregiver is associated with lower performance on cognitive development tests in some sites, while greater wealth is associated with higher performance. There is no significant association between orphan status per se and cognitive development, though the negative and significant association between higher emotional difficulties and lags in cognitive development hold across all orphan subgroups.
  
  
  CONCLUSIONS
  These findings suggest that interventions targeting psychosocial support for vulnerable children, especially vis a vis traumatic experiences, may ease strains inhibiting a child's learning. Family based interventions to stabilize socioeconomic conditions may help overcome psychosocial challenges that otherwise would present as barriers to the child's learning.
authors.affiliation: Terry Sanford Institute of Public Policy, Duke University, Durham, NC, USA. mme8@duke.edu.
authors.forename: Maya
authors.initials: M
authors.lastname: Escueta
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whetten
authors.forename: Jan
authors.initials: J
authors.lastname: Ostermann
authors.forename: Karen
authors.initials: K
authors.lastname: O'Donnell
mesh_terms: D000342:Affective Symptoms / Q000453:epidemiology*; D000351:Africa, Eastern / Q000453:epidemiology; D002160:Cambodia / Q000453:epidemiology; D017028:Caregivers / Q000706:statistics & numerical data; D002648:Child; D002657:Child Development; D002670:Child, Abandoned / Q000523:psychology* / Q000706:statistics & numerical data; D054540:Child, Orphaned / Q000523:psychology* / Q000706:statistics & numerical data; D003071:Cognition / Q000502:physiology; D003906:Developing Countries; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D011581:Psychological Tests / Q000706:statistics & numerical data; D012044:Regression Analysis; D012737:Sex Factors; D012959:Socioeconomic Factors