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.

Method: 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.

Conclusion: 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.

Clinical trial registration information: The Bucharest Early Intervention Project; https://ichgcp.net/clinical-trials-registry/NCT00747396" title="See in ClinicalTrials.gov">NCT00747396.

Keywords: callous-unemotional traits; deprivation; early adversity; foster care; prevention.

Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

FIGURE 1

Group status in early adolescence for children living in Romanian institutions who were assigned to usual care or foster care (Consolidated Standards of Reporting [CONSORT] diagram). Note: ICU = Inventory of Callous-Unemotional Traits.

FIGURE 2

Proposed multiple mediation of caregiver warmth and caregiver responsiveness to distress as mediators of the association between intervention group and callous-unemotional traits, moderated by child’s sex.