title: Social communication difficulties and autism in previously institutionalized children.
abstract: OBJECTIVE
  To determine the risk of difficulties with social communication and restricted/repetitive behaviors as well as the rate of autism in children institutionalized in early infancy and to assess the impact of a foster care intervention on ameliorating this risk.
  
  
  METHODS
  Children abandoned at birth and raised in institutions in Bucharest, Romania were randomly assigned to a care-as-usual group (institutional care, CAUG), or placed in family-centered foster care (FCG) as part of the Bucharest Early Intervention Project (BEIP). At approximately 10 years of age, the Social Communication Questionnaire (SCQ) was administered to caregivers of children in both groups as well as to parents of a typically developing community sample (Never-Institutionalized group [NIG]) residing in Bucharest, Romania. Children scoring ≥12 on the SCQ underwent clinical evaluation for autism spectrum disorder (ASD).
  
  
  RESULTS
  Caregivers of children with a history of institutionalization reported that these children had significantly more deviant behavior than never-institutionalized children on all subdomains of the SCQ (all p < 0.001). Children in the FCG had significantly lower scores on the SCQ than children in the CAUG (p < .001), particularly in the reciprocal social interaction domain, indicating that the intervention reduced problems in social communication. Three of 60 CAUG children, 2 of 57 FCG children, and none of the NIG children received a formal ASD diagnosis.
  
  
  CONCLUSIONS
  Early institutional rearing was associated with an increased risk of social communication difficulties and ASD. A family-centered foster care intervention improved social communication skills.
authors.affiliation: Boston Children's Hospital/Harvard Medical School, Boston. Electronic address: April.Levin@childrens.harvard.edu.
authors.forename: April R
authors.initials: AR
authors.lastname: Levin
authors.affiliation: University of Maryland, College Park.
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Fox
authors.affiliation: Tulane University School of Medicine, New Orleans.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Zeanah
authors.affiliation: Laboratories of Cognitive Neuroscience at Boston Children's Hospital/Harvard Medical School, and the Harvard Center on the Developing Child, Cambridge, MA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Nelson
mesh_terms: D000067877:Autism Spectrum Disorder / Q000175:diagnosis*; D017028:Caregivers; D002648:Child; D002657:Child Development; D002674:Child, Institutionalized / Q000523:psychology*; D002675:Child, Preschool; D003142:Communication; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018479:Early Intervention, Educational; D005260:Female; D005500:Follow-Up Studies; D005581:Foster Home Care; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D019372:Orphanages; D012383:Romania; D066107:Social Skills
keywords: autism; development; foster care; institutional care; social communication