Fisher Philip A, Mannering Anne M, Van Scoyoc Amanda, Graham Alice M
Child Welfare. 2013;92(5):9-36.
Placement instability is a common occurrence among foster children and others involved with child welfare system services, and is associated with negative psychiatric and mental health outcomes. The purpose of this paper is to review and synthesize research in this area and to consider this information in terms of child welfare practice and policy. Evidence from 59 sources is reviewed, including research on (a) the connection between placement instability and poor outcomes; (b) sources of information that can be employed to reliably predict risk for placement instability; and (c) interventions designed to mitigate the effects of placement instability. The available empirical evidence suggests that placement instability and other family chaos is associated with disrupted development of the brain’s prefrontal cortex, which is involved in executive functioning. Poor executive functioning is implicated in elevated risk for ADHD, disruptive behavior disorders, substance abuse, and other forms of disinhibitory psychopathology. This might help to explain the high rates of psychiatric medication prescriptions for foster children. Notably, however, recent research findings have shown that placement instability is both predictable and preventable and that interventions to address placement instability have the potential to mitigate neurobiological and psychiatric effects of prior adversity.
安置不稳定在寄养儿童及其他接受儿童福利系统服务的人群中很常见，且与负面的精神和心理健康结果相关。本文旨在回顾和综合该领域的研究，并从儿童福利实践和政策的角度考量这些信息。我们对来自59个来源的证据进行了回顾，包括关于以下方面的研究：（a）安置不稳定与不良后果之间的联系；（b）可用于可靠预测安置不稳定风险的信息来源；以及（c）旨在减轻安置不稳定影响的干预措施。现有的实证证据表明，安置不稳定和其他家庭混乱与大脑前额叶皮质发育受阻有关，前额叶皮质参与执行功能。执行功能不佳与患多动症、破坏性行为障碍、药物滥用及其他形式的抑制解除性精神病理学的风险升高有关。这或许有助于解释寄养儿童精神类药物处方的高开出率。然而，值得注意的是，最近的研究结果表明，安置不稳定是可预测且可预防的，针对安置不稳定的干预措施有可能减轻先前逆境的神经生物学和精神影响。
