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Presentation to The Way Forward Project February 10, 2011 Mary Dozier. The Scientific Basis for Family-Based Care. Babies and Young Children. Biologically prepared to depend on caregivers. Infant reliance on parent. Temperature regulation Neuroendocrine regulation

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the scientific basis for family based care

Presentation to

The Way Forward Project

February 10, 2011

Mary Dozier

The Scientific Basis for Family-Based Care

slide3

Babies and Young Children

  • Biologically prepared to depend on caregivers
infant reliance on parent
Infant reliance on parent
  • Temperature regulation
  • Neuroendocrine regulation
  • Protection from infection
  • Protection from danger
  • Contact comfort
  • Security
attachment as evolutionarily based system
Attachment as evolutionarily based system

When child is capable of moving away, important that there is a system in place than ensures that he or she stays close under conditions of threat

development of attachment is canalized
Development of attachment is “canalized”
  • Child will develop attachment under almost all conditions
    • Regardless of whether:
      • Parent is insensitive
      • Parent is mother, father, grandparent, unrelated
      • Parent maltreats child
    • Robust system
having one s own parent
Having one’s own parent
  • Likely an “experience expectant” condition
    • Not something that was expected to vary for different members of the species
    • Human infants rarely survived if they did not have parent (surrogate parent) who took care of them
    • So, did not have to be equipped to deal with lack of parental care
slide8

As the result of how evolution has occurred, human infants are dependent on parents for a number of things

    • If child does not have parent, it’s not just attachment that is thrown off, but development more generally
      • Relationship serves to support physiological development, cognitive development, social development
why institutional care is problematic
Why institutional care is problematic
  • Child does not have own parent (or surrogate parent)
    • Staff work shifts (e.g., work 8-12 hours, then others come on)
    • High child to caregiver ratio (have little time for individual children)
    • Staff rather than parents (think of this as job)
why institutional care is problematic1
Why institutional care is problematic
  • Babies “designed” to have someone who is there for them: someone committed
    • they’re “designed” to deal with caregivers who differ, but not designed for staff (changing caregivers, shifts, etc.)
young children in institutional care
Young children in institutional care

Lack stimulation

Lack co-regulator

Lack attachment figure

institutional care adversely affects
Institutional care adversely affects:
  • Attachment
  • Physical growth
  • Intellectual development
    • Attention
  • Physiological regulation
  • Quasi-autistic symptoms
attachment
Attachment
  • 3 issues:
    • Does child form attachment?
    • Does child develop secure and/or organized attachment?
    • Does child show indiscriminately friendly behavior toward strangers?
development of attachment is canalized1
Development of attachment is “canalized”
  • Child will develop attachment under almost all conditions
      • Does not always occur among children in institutions
does child form attachment
Does child form attachment?
  • Zeanah, Smyke, Nelson, Fox, et al. (2005) studied attachment behaviors among children in institutions and among children who had been raised in families
    • Rated children regarding how clear attachment behavior on 5 point scale:
      • 1: No evidence of attachment behavior
      • 3: Fragmented sequences of attachment behavior
      • 5: Clear, classifiable attachment
slide16
Percentage of children in families and in institutions rated as having clear, classifiable attachments

Percentage of children with clear attachments

Zeanah et al., 2005

attachment1
Attachment
  • 3 issues:
    • Does child form attachment?
      • Virtually all children in family based care form attachments;
      • Few children in institutions show clear, classifiable attachments
attachment2
Attachment
  • 3 issues:
    • Does child form attachment?
    • Does child form organized attachment?
    • Does child show intimate behavior toward strangers?
attachment quality
Attachment quality
  • Organized attachment: has strategy for maintaining maximal proximity to parent
    • Secure: can go to parent when distressed and get whatever comfort needed
    • Insecure: may not go to parent, or may go and not be easily soothed, but has a strategy
  • Disorganized: breakdown in strategy
attachment quality1
Attachment quality
  • Secure: can go to parent when distressed and get whatever comfort needed
  • Insecure: may not go to parent, or may go and not be easily soothed, but has a strategy
  • Disorganized: breakdown in strategy
disorganized attachment
Disorganized attachment
  • Associated with problematic outcomes
    • Most especially, externalizing behavior (getting in trouble)
      • Meta-analysis of Fearon et al. (2010)
slide22
Percentage of children in families and in institutions rated as having clear, classifiable attachments

Percentage

Zeanah et al., 2005

attachment3
Attachment
  • 3 issues:
    • Does child form attachment?
    • Does child form organized attachment?
    • Does child show intimate behavior toward strangers?
indiscriminate sociability
Indiscriminate Sociability

Child shows behavior toward stranger typically reserved for primary caregiver

percentage of children in families and in institutions rated as showing indiscriminate sociability
Percentage of children in families and in institutions rated as showing indiscriminate sociability

Percentage

Zeanah et al., 2005; O’Connor et al., 2000

physical growth
Physical growth
  • Significant stunting of growth
    • Height
    • Head circumference
    • Johnson et al. (1994)
    • Smyke, Nelson, et al. (2007)

Photo from UM International Adoption Clinic, Johnson et al.

intellectual development
Intellectual development
  • Lower IQ
    • Population mean = 100
    • Rutter and colleagues (Beckett et al., 2002) found mean IQ of 50 among children in Romanian orphanages
    • van IJzendoorn et al. (2008) meta-analysis mean of 20 points lower than other children
intellectual development1
Intellectual development
  • Lower alpha power/higher theta power – consistent with less cortical maturation

(Marshall, Fox, Zeanah et al., 2004; 2010)

intellectual development2
Intellectual development
  • Lower alpha power/higher theta power – consistent with less cortical maturation
    • Marshall, Fox, Nelson, et al., 2004, 2010
  • Particular problems with attention
    • Gunnar et al., 2000
    • Nelson et al., 2009
    • Rutter et al., 2010
family based care
Family-based care
  • Bucharest Early Intervention Project (Nelson, Fox, Zeanah, et al.)
    • Random assignment of children to family-based or continued orphanage care
    • Reversal of many deficits
  • Van IJzendoorn, Juffer et al. meta-analyses
    • Power of family-based care