Published January 14, 2015
Behavioral tics such as head banging, hand flapping, and body rocking are more common in toddlers living in orphanages, but often disappear after children are placed in foster homes, a new Romanian study shows.
The earlier the children were removed from the orphanage and the longer they lived with their foster family, the larger the reduction in tics. Such tics are common in children with autism, but it is unclear whether they are related to brain damage, the authors note.
"These results underscore the need for early placement in home-based care for abandoned children," they write in the May issue of Archives of Pediatrics and Adolescent Medicine.
Dr. Charles Nelson, of Children's Hospital in Boston, and colleagues turned to data from the Bucharest Early Intervention Project, a study conducted at the invitation of the Romanian government by American investigators of 187 current and formerly institutionalized children.
The study assigned 68 children to closely monitored quality foster care, and 68 to remain in an orphanage. The average age was about 23 months.
At the start of the study, more than 60 percent of the children exhibited some or many behavioral tics. (For comparison, only about 20 percent of a group of children raised with their families in the Bucharest area and studied separately by the same group had any such tics.)
While the behaviors declined over time in the children who stayed in the orphanage as well as those who went to foster homes, the latter had fewer tics. At four and a half years into the study, just under half of the institutionalized children still had some or many tics, while just under a third of the foster care kids did.
Age at placement made a big difference; the older the child at placement in foster care the more likely to exhibit tics at each follow-up assessment. At 54 months, none of the children placed before they turned one exhibited any of the studied behaviors, compared to 43 percent of the children placed after the age of two.
Most children placed in foster homes, the authors write, experience a drop in tic activity, "suggesting recovery is possible."
While most orphanages in the US were closed in favor of foster care by 1970, Nelson said his team's findings are relevant to poorly chosen and monitored foster care settings that should be considered a form of neglect. "Institutionalization is just a more severe form of neglect," he told Reuters Health.
The study of Romanian children helps illustrate the need to better understand the role "secure and functional caregiver relationships" plays in creating healthy and resilient children, Dr. David Rubin and Kathleen Noonan, co-directors of the Policy Lab at Children's Hospital in Philadelphia, write in an editorial accompanying the study.
Researchers aren't sure about the best way to prevent or treat such tics, which can disrupt daycare, school, and family life, Rubin told Reuters Health. Medications are often the only treatments available, even when talk therapy might work better.
"Our public health systems lag behind in the adoption of these promising interventions," they write.