title: High-Quality Foster Care Mitigates Callous-Unemotional Traits Following Early Deprivation in Boys: A Randomized Controlled Trial.
abstract: OBJECTIVE
  Callous-unemotional (CU) traits in childhood are a developmental precursor to psychopathy, yet the origins and etiology of CU traits are not known. We examined CU traits among 12-year-old children exposed to severe early deprivation and evaluated whether a high-quality foster care intervention mitigated the development of high levels of CU traits.
  
  
  METHODS
  Participants were from the Bucharest Early Intervention Project, a randomized controlled trial of foster care for children in institutions. Children were recruited from institutions in Bucharest, Romania, along with age- and sex-matched children who were never institutionalized. Children raised in institutional settings were randomized (mean age = 22 months) to either a foster care group (n = 68) or a care-as-usual group (n = 68). CU traits were assessed at age 12.75 years in available participants from the randomized trial (n = 95) and children who were never institutionalized (n = 50).
  
  
  RESULTS
  Children who experienced institutional rearing as young children had significantly higher levels of CU traits in early adolescence compared to children who were never institutionalized. Intent-to-treat analysis indicated that, among boys, CU traits were significantly lower among those who received the foster care intervention compared to those randomized to care as usual. Caregiver responsiveness to distress, but not caregiver warmth, mediated the intervention effect on CU traits in boys.
  
  
  CONCLUSIONS
  These findings provide the first evidence to date that psychosocial intervention can prevent the onset of CU traits. Although severe early deprivation predicted higher levels of CU traits, high-quality foster care that emphasized responsive caregiving reduced the impact of deprivation on CU trait development for boys.
  
  
  BACKGROUND
  The Bucharest Early Intervention Project; http://clinicaltrials.gov; NCT00747396.
authors.affiliation: Tulane University School of Medicine, New Orleans.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Humphreys
authors.affiliation: Wayne State University, Detroit.
authors.forename: Lucy
authors.initials: L
authors.lastname: McGoron
authors.affiliation: Boston Children's Hospital and Harvard University, Cambridge, MA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Sheridan
authors.affiliation: University of Washington, Seattle.
authors.forename: Katie A
authors.initials: KA
authors.lastname: McLaughlin
authors.affiliation: University of Maryland, College Park.
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Fox
authors.affiliation: Boston Children's Hospital/Harvard University and Harvard Graduate School of Education, Cambridge.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Nelson
authors.affiliation: Tulane University School of Medicine, New Orleans. Electronic address: czeanah@tulane.edu.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Zeanah
mesh_terms: D000293:Adolescent; D000987:Antisocial Personality Disorder / Q000451:nursing*; D017028:Caregivers; D002648:Child; D002674:Child, Institutionalized / Q000523:psychology*; D004645:Empathy; D005260:Female; D005581:Foster Home Care / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011610:Psychosocial Deprivation; D012383:Romania; D012737:Sex Factors
keywords: callous-unemotional traits; deprivation; early adversity; foster care; prevention