Mount Sinai Adolescent Health Center, Department of Pediatrics, 320 E 94th St, New York, NY 10128, USA.
Pediatrics. 2010 Mar;125(3):e489-98. doi: 10.1542/peds.2009-1285. Epub 2010 Feb 1.
It is largely unknown whether symptoms of inattention and hyperactivity/impulsivity of foster children decline over time after placement and what the role of the quality and stability of the foster placement is on the course of attention-deficit hyperactivity disorder (ADHD) symptom trajectories. Longitudinal studies of normative trajectories of symptom types in nonreferred children may assist in appropriately diagnosing ADHD and designing the clinical treatment for foster children.
We described average level and slope of inattention and hyperactivity/impulsivity symptoms over time and examined parental (biological and foster) warmth and hostility and placement stability (number of foster-home moves and discharge from care) as reported by 3 informants (biological parent, foster parent, and classroom teacher) after considering maltreatment risks (child age, gender, sibling ADHD, and comorbidity) and use of ADHD medication.
We studied 252 maltreated children in 95 families during 4 yearly waves, beginning shortly after placement; children were assessed whether they remained in or were discharged from foster care.
Average level of inattention declined according to the biological parent, whereas hyperactivity/impulsivity symptoms declined according to both biological and foster parents. Higher inattention was associated with lower parental warmth (foster parent), higher parental hostility (biological, foster, and teacher), and discharge from care (biological parent). Higher hyperactivity was also associated with lower parental warmth (foster parent) and higher parental hostility (biological and foster parent), higher (average) number of foster-home moves, and discharge from care (biological report). Higher teacher-derived hyperactivity symptoms were associated with a history of child abuse (versus neglect); however, abused children showed a steeper decline of hyperactivity over time than those with neglect histories. Unexpected interactions were found for the impact over time of parental (foster) warmth and number of foster-home moves.
Findings point to the clinical usefulness of attending to the parenting quality and placement stability as malleable factors affecting symptom reduction subsequent to placement.
寄养儿童的注意力不集中和多动/冲动症状在安置后是否会随着时间的推移而逐渐减轻，以及寄养安置的质量和稳定性对注意缺陷多动障碍（ADHD）症状轨迹的影响如何，目前还知之甚少。对非被推荐儿童的症状类型的纵向研究可能有助于正确诊断 ADHD，并为寄养儿童设计临床治疗方案。
我们描述了在考虑虐待风险（儿童年龄、性别、兄弟姐妹 ADHD 和共病）和 ADHD 药物使用后，3 名报告者（亲生父母、寄养父母和班主任）报告的注意缺陷和多动冲动症状随时间的平均水平和斜率，并检查了父母（亲生和寄养）的温暖和敌意以及安置稳定性（寄养家庭的搬迁次数和离开护理）。
我们在 4 年的时间里研究了 95 个家庭中的 252 名受虐待儿童，从安置后不久开始；评估儿童是否仍在寄养或已离开寄养。
根据亲生父母的报告，注意缺陷的平均水平下降，而根据亲生父母和寄养父母的报告，多动冲动症状下降。较高的注意力不集中与较低的父母温暖（寄养父母）、较高的父母敌意（亲生、寄养和教师）以及离开护理（亲生父母）有关。较高的多动冲动也与较低的父母温暖（寄养父母）和较高的父母敌意（亲生和寄养父母）、较高的（平均）寄养家庭搬迁次数以及离开护理（亲生报告）有关。教师报告的多动症状较高与儿童遭受虐待（而非忽视）有关；然而，与有忽视史的儿童相比，遭受虐待的儿童的多动症状随时间的推移下降更为明显。我们还发现了一些意想不到的互动，即父母（寄养）温暖和寄养家庭搬迁次数对随时间变化的影响。
研究结果表明，关注育儿质量和安置稳定性作为影响安置后症状减轻的可改变因素具有临床意义。
