13 May 2010

Tics common in orphanages

Behavioural tics such as head banging, hand flapping, and body rocking are more common in toddlers living in orphanages, but often disappear in foster care, a new study shows.

Behavioural 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 Paediatrics and Adolescent Medicine.

How the study was done

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% of the children exhibited some or many behavioural tics. (For comparison, only about 20% 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 behaviours 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.

Tics dissapeared in foster care

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 behaviours, compared to 43% 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 favour 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.

Caregiver relationship important

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 day-care, 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. (Rachael Myers Lowe/Reuters Health, May 2010)

SOURCE:  Archives of Paediatrics and Adolescent Medicine, May, 2010.




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