Author: matthew

A Brief Assessment of Learning for Orphaned and Abandoned Children in Low and Middle Income Countries

Written by matthew on . Posted in Educational Impact, Psychological Effects of Orphanhood. Leave a Comment

Title: A Brief Assessment of Learning for Orphaned and Abandoned Children in Low and Middle Income Countries

Authors: Karen O’Donnell, Robert Murphy, Jan Ostermann, Max Masnick, Rachel A. Whetten, Elisabeth Madden, Nathan M. Thielman, Kathryn Whetten and The Positive Outcomes for Orphans (POFO) Research Team

Date: 2012

Abstract: Assessment of children’s learning and performance in low and middle income countries has been critiqued as lacking a gold standard, an appropriate norm reference group, and demonstrated applicability of assessment tasks to the context. This study was designed to examine the performance of three nonverbal and one adapted verbal measure of children’s problem solving, memory, motivation, and attention across five culturally diverse sites. The goal was to evaluate the tests as indicators of individual differences affected by life events and care circumstances for vulnerable children. We conclude that the measures can be successfully employed with fidelity in non-standard settings in LMICs, and are associated with child age and educational experience across the settings. The tests can be useful in evaluating variability in vulnerable child outcomes.

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Guest Post:Traumatic experiences during childhood can leave genetic scars, studies find

Written by matthew on . Posted in Blog: News, Events and Opinion. Leave a Comment

Although standard theory suggests that genes are not supposed to change as they are passed down generations, recent studies have found that mistreatment as a child can physically affect one’s genetic material. The recent findings could have important implications on orphan and vulnerable children research, especially projects that pertain to the long-term effects of childhood trauma.

A recent Wall Street Journal article discusses the research results of two recent studies that link exposure to traumatic events—such as bullying, beating and domestic violence—and genetic “scarring.” As a part of one study, researchers examined the effect of psychosocial stress on the physical makeup of telomeres, or regions of genetic sequences on the end of chromosomes. Telomeres are partially meant for protection—they safeguard the chromosome from deterioration and from fusing with other chromosomes. These sequences deteriorate over time—a natural process, but one that is more rapid among people who recall psychosocial stress during childhood, researchers found.

Specifically, Stacy Drury, a professor of psychiatry and neurology at Tulane University, and coworkers discovered that the telomeres of children who resided in Bucharest orphanages were shorter than those who lived in foster families. Another cohort of the research team, from Duke University, used blood samples from study participants—which had been collected throughout their lives—to discover that telomeres shrink more rapidly, on average, in participants who experienced violence. The findings are not completely clear, however—the telomeres grew longer among some individuals.

Another study that the Wall Street Journal article highlights discovered that stress during childhood—either through maltreatment or through the loss of a parent—”results in greater ‘methylation’ of some spots near a gene tied to stress response in adulthood.” This finding is explained in further detail below:

[box] “Methylation, the addition of a methyl group of atoms to one DNA ‘letter,’ tends to reduce the activity of nearby genes. The implication of the Butler study is that adults who recall maltreatment as children may have reduced activity of a key gene in the system that responds to the stress hormone cortisol. This may be linked to increased anxiety or depression.

These are early days in the study of epigenetics. Scientists are like people finding coins under lampposts but not knowing how many coins remain in the dark. Although the ‘methylome’—a complete map of where methylation happens in the genome—is being talked of, others caution that we still have almost no idea of both the causes and effects of most such changes, let alone other epigenetic effects like histone modification.”[/box]

Though the implications of these recent studies is not entirely clear, it is important to note that some of these findings contrast with certain studies published on this site. For instance, the discovery that living in a Bucharest orphanage resulted in shorter telomeres than residing in a foster home conflicts with the finding of Positive Outcomes for Orphans, a longitudinal study conducted across the world that discovered that health, emotional and cognitive functioning, and physical growth were no worse for institution-residing than community-residing orphaned and abandoned children. In other words, the study discovered that living environment—institutional care versus community care—explained very little of the variability in child outcomes.

This study and others demonstrate that early life experiences can have long-term effects—regardless of whether such experiences result in physical DNA damage, or merely influence the emotional and physical wellbeing of an orphan. It will be important to see how studies like these impact policy outcomes, especially regarding the closure orphanages.

 Please respond to this article in our discussion forum.

Psychological distress amongst AIDS-orphaned children in urban South Africa

Written by matthew on . Posted in Psychological Effects of Orphanhood. Leave a Comment

Title: Psychological distress amongst AIDS-orphaned children in urban South Africa

Authors: Lucie Cluver, Frances Gardner, Don Operario

Date: 2007

Abstract: BACKGROUND: South Africa is predicted to have 2.3 million children orphaned by Acquired Immune Deficiency Syndrome (AIDS) by 2020 (Actuarial Society of South Africa, 2005). There is little knowledge about impacts of AIDS-related bereavement on children, to aid planning of services. This study aimed to investigate psychological consequences of AIDS orphanhood in urban township areas of Cape Town, South Africa, compared to control groups of children and adolescents orphaned by other causes, and non-orphans. METHOD: One thousand and twenty-five children and adolescents (aged 10-19) were interviewed using socio-demographic questionnaires and standardised scales for assessing depression, anxiety, post-traumatic stress, peer problems, delinquency and conduct problems. RESULTS: Controlling for socio-demographic factors such as age, gender, formal/informal dwelling and age at orphanhood, children orphaned by AIDS were more likely to report symptoms of depression, peer relationship problems, post-traumatic stress, delinquency and conduct problems than both children orphaned by other causes and non-orphaned children. Anxiety showed no differences. AIDS-orphaned children were more likely to report suicidal ideation. Compared to Western norms, AIDS-orphaned children showed higher levels of internalizing problems and delinquency, but lower levels of conduct problems. CONCLUSIONS: Children orphaned by AIDS may be a particularly vulnerable group in terms of emotional and, to a lesser extent, behavioural problems. Intervention programs are necessary to ameliorate the psychological sequelae of losing a parent to AIDS.

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Posttraumatic stress in AIDS-orphaned children exposed to high levels of trauma: the protective role of perceived social support

Written by matthew on . Posted in Psychological Effects of Orphanhood. Leave a Comment

Title: Posttraumatic stress in AIDS-orphaned children exposed to high levels of trauma: the protective role of perceived social support

Authors: Lucie Cluver, Dylan S Fincham, Soroya Seedat

Date: 2009

Abstract: Poor urban children in South Africa are exposed to multiple community traumas, but AIDS-orphaned children are at particular risk for posttraumatic stress. This study examined the hypothesis that social support may moderate the relationship between trauma exposure and posttraumatic stress for this group. Four hundred twenty-five AIDS-orphaned children were interviewed using standardized measures of psychopathology. Compared to participants with low perceived social support, those with high perceived social support demonstrated significantly lower levels of PTSD symptoms after both low and high levels of trauma exposure. This suggests that strong perception of social support from carers, school staff, and friends may lessen deleterious effects of exposure to trauma, and could be a focus of intervention efforts to improve psychological outcomes for AIDS-orphaned children.

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Prevalence of parental death among young people in South Africa and risk for HIV infection

Written by matthew on . Posted in Longterm Consequences of Orphanhood, OVC and HIV/AIDS. 1 Comment

Title: Prevalence of parental death among young people in South Africa and risk for HIV infection

Authors: Don Operario, Audrey Pettifor, Lucie Cluver, Catherine MacPhail, Helen Rees

Date: 2007

Abstract: OBJECTIVES: This study estimated the prevalence and sociodemographic characteristics of young people in South Africa who have experienced parental death and examined associations between parental death and young people’s HIV status and sexual behaviors. DESIGN AND METHODS: Data were from a cross-sectional nationally representative household survey of 11,904 15- to 24-year-old South Africans. Surveys included items on sexual behavior and family composition, and oral fluid samples were collected to test for HIV status. RESULTS: The prevalence of parental death was 27.3% overall: 22.4% reported a father deceased, 7.9% reported a mother deceased, and 3.0% reported both parents deceased. Parental death was disproportionately associated with black ethnicity, impoverished household living conditions, lack of an adult guardian in the home, and not completing compulsory education levels. Controlling for sociodemographic factors, parental death among female participants was significantly associated with HIV-positive status (odds ratio OR = 1.25, 95% confidence interval CI: 1.08 to 1.44), ever having had oral sex (OR = 1.23, 95% CI: 1.02 to 1.49), ever having had vaginal sex (OR = 1.38, 95% CI: 1.19 to 1.60), and having more than 1 sex partner during the past year (OR = 1.33, 95% CI: 1.07 to 1.64). Among male participants, parental death was significantly associated with ever having had vaginal sex (OR = 1.19, 95% CI: 1.04 to 1.36) and having unprotected sex at the last sexual episode (OR = 1.23, 95% CI: 1.07 to 1.42). CONCLUSIONS: More than one quarter of young South Africans have experienced parental death. Death of a parent is associated with young female South Africans’ HIV status and sexual behaviors among young female and male South Africans. HIV prevention interventions are necessary to address the specific needs of young South Africans who have experienced parental death.

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Orphanhood and Completion of Compulsory School Education Among Young People in South Africa: Findings From a National Representative Survey

Written by matthew on . Posted in Educational Impact. 1 Comment

Title: Orphanhood and Completion of Compulsory School Education Among Young People in South Africa: Findings From a National Representative Survey

Authors: Don Operario, Lucie Cluver, Helen Rees, Catherine MacPhail, Audrey Pettifor

Date: Feb. 21, 2008

Abstract: We examined the association of orphanhood and completion of compulsory school education among young people in South Africa. In South Africa, school attendance is compulsory through grade 9, which should be completed before age 16. However, family and social factors such as orphanhood and poverty can hinder educational attainment. Participants were 10,452 16–24-year-olds who completed a South African national representative household survey. Overall, 23% had not completed compulsory school levels. In univariate analyses, school completion was lower among those who had experienced orphanhood during school-age years, males, and those who reported household poverty. In multivariate analyses controlling for household poverty, females who had experienced maternal or paternal orphanhood were less likely to have completed school; orphanhood was not independently associated with males’ school completion. Findings highlight the need for evidence-informed policies to address the education and social welfare needs of orphans and vulnerable youth, particularly females, in South Africa.

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AIDS-Orphanhood and Caregiver HIV/AIDS Sickness Status: Effects on Psychological Symptoms in South African Youth

Written by matthew on . Posted in OVC and HIV/AIDS, Psychological Effects of Orphanhood. Leave a Comment

Title: AIDS-Orphanhood and Caregiver HIV/AIDS Sickness Status: Effects on Psychological Symptoms in South African Youth

Authors: Lucie Cluver, Mark Orkin, Mark E Boyes, Frances Gardner, Joy Nikelo

Date: Feb, 7, 2012

Abstract: 

OBJECTIVE:

Research has established that AIDS-orphaned youth are at high risk of internalizing psychological distress. However, little is known about youth living with caregivers who are unwell with AIDS or youth simultaneously affected by AIDS-orphanhood and caregiver AIDS sickness.

METHODS:

1025 South African youth were interviewed in 2005 and followed up in 2009 (71% retention). Participants completed standardized measures of anxiety, depression, and posttraumatic stress. Comparison groups were youth who were AIDS-orphaned, other-orphaned, and nonorphaned, and those whose caregivers were sick with AIDS, sick with another disease, or healthy.

RESULTS:

Longitudinal analyses showed that both AIDS-orphanhood and caregiver AIDS sickness predicted increased depression, anxiety, and posttraumatic stress symptoms over a 4-year period, independently of sociodemographic cofactors and of each other. Caregiver sickness or death by non-AIDS causes, and having a healthy or living caregiver, did not predict youth symptomatology. Youths simultaneously affected by caregiver AIDS sickness and AIDS-orphanhood showed cumulative negative effects.

CONCLUSIONS:

Findings suggest that policy and interventions, currently focused on orphanhood, should include youth whose caregivers are unwell with AIDS.

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Persisting mental health problems among AIDS-orphaned children in South Africa

Written by matthew on . Posted in Psychological Effects of Orphanhood. Leave a Comment

Title: Persisting mental health problems among AIDS-orphaned children in South Africa

Authors: Lucie Cluver, Mark Orkin, Frances Gardner, Mark E Boyes

Date: 2011

Abstract:

BACKGROUND:

By 2008, 12 million children in sub-Saharan Africa were orphaned by AIDS. Cross-sectional studies show psychological problems for AIDS-orphaned children, but until now no longitudinal study has explored enduring psychological effects of AIDS-orphanhood in low-income countries.

METHODS:

A 4-year longitudinal follow-up of AIDS-orphaned children with control groups of other-orphans and non-orphans. 1021 children (M = 13.4 years, 50% female, 98% isiXhosa-speaking) were interviewed in 2005 and followed up in 2009 with 71% retention (49% female, M = 16.9 years), in poor urban South African settlements. Children were interviewed using sociodemographic questionnaires and well-validated standardised scales for assessing depression, anxiety, and post-traumatic stress. Data were analysed using mixed-design ANOVA and backward-stepping regression.

RESULTS:

AIDS-orphaned children showed higher depression, anxiety, and post-traumatic stress disorder (PTSD) scores in both 2005 and 2009 when compared with other-orphans and non-orphans. Backward-stepping regression, controlling for baseline mental health, and sociodemographic cofactors such as age, gender, and type of bereavement, revealed that being AIDS-orphaned in 2005 was associated with depression, anxiety, and PTSD scores in 2009. This was not the case for other-orphaned or non-orphaned children. Age interacted with orphan status, such that there was a steep rise in psychological distress in the AIDS-orphaned group, but no rise with age amongst other-orphans and non-orphans.

CONCLUSIONS:

Negative mental health outcomes amongst AIDS-orphaned children are maintained and worsen over a 4-year period. It is important that psychosocial support programmes are sustained, and focus on youth as well as young children.

Multimedia:

httpv://www.youtube.com/watch?v=ttDinnYOoiM

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Effects of stigma on the mental health of adolescents orphaned by AIDS

Written by matthew on . Posted in Psychological Effects of Orphanhood. Leave a Comment

Title: Effects of stigma on the mental health of adolescents orphaned by AIDS

Authors: Lucie Cluver, Frances Gardner, Don Operario

Date: 2008

Abstract:

PURPOSE:

By 2010, an estimated 18.4 million children in Sub-Saharan Africa will be orphaned by AIDS. Research in South Africa shows that AIDS orphanhood is independently associated with heightened levels of psychological problems. This study is the first to explore the mediating effects of stigma and other factors operating on a community level, on associations between AIDS orphanhood and mental health. We assessed the associations of four risk factors that can potentially be addressed at a community level (bullying, stigma, community violence, and lack of positive activities) with psychological problems and orphanhood status.

METHOD:

One thousand twenty-five participants aged 10-19 were recruited from deprived urban settlements in South Africa. The sample included adolescents orphaned by AIDS (n = 425), adolescents orphaned by non-AIDS causes (n = 241), and nonorphaned adolescents (n = 278). Participants were interviewed using standardized psychological measures of depression, anxiety, posttraumatic stress, peer problems, delinquency, and conduct problems. Information on risk factors and demographic characteristics were also assessed.

RESULTS:

AIDS-orphaned adolescents reported higher levels of stigma and fewer positive activities than other groups. There were no reported differences on bullying or community violence. All community-level risk factors were associated with poorer psychological outcomes. Multivariate analyses controlling for age and gender showed that experience of stigma significantly mediated associations between AIDS orphanhood and poor psychological outcomes.

CONCLUSIONS:

Reduction of AIDS-related stigma could potentially reduce adverse psychological outcomes among AIDS-orphaned adolescents.

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Improving Outcomes for Youth in Foster Care: Trauma-Focused CBT

Written by matthew on . Posted in Emotional Wellbeing, Training and Therapy. Leave a Comment

Study Title: Improving Outcomes for Youth in Foster Care: Trauma-Focused CBT

Context: Children and adolescents in foster care have significant, and often unmet, mental health needs (Leslie, Hurlburt, Landsverk, & Barth, 2004). For school-aged youth, the most common problems are disruptive behavior disorders and sequelae of trauma exposure (e.g., Posttraumatic Stress Disorder [PTSD], Depression) (Landsverk, Burns, & Stambaugh, in press). Such mental health problems, in turn, are linked to a range of negative outcomes (e.g., functioning, placement stability/permanency) (James, Landsverk, & Slymen, 2004; Landsverk, Davis, Granger, Newton, & Johnson, 1996). There is tremendous interest in the field to increase use of evidence-based treatments that target specific mental health problems and needs of youth in foster care. Trauma-focused Cognitive Behavioral Therapy (TF-CBT) potentially provides an excellent fit. Evidence from randomized trials supports the efficacy of TF-CBT in treating PTSD, behavior problems, and other trauma sequelae (Cohen, Deblinger, Mannarino, & Steer, 2004). Although TF-CBT holds promise for youth in foster care, there are likely complexities in providing it to such youth. Findings from dismantling research indicate that caregiver involvement is crucial for maximizing treatment effects of TF-CBT (Deblinger, Lippman, & Steer, 1996). However, available evidence and our clinical experience suggest that foster parents are infrequently engaged in a proactive and ongoing manner in their foster children’s mental health treatment.

Study Aims: Therefore the primary aim of the proposed R34 is to conduct a pilot study of TF-CBT with children and adolescents in foster care, with a targeted focus on engaging foster parents in treatment. The proposed project brings together two complementary interventions-evidence-based engagement strategies (McKay, Stoewe, McCadam, & Gonzales, 1998) and TF-CBT (Cohen, Deblinger & Mannarino, 2006; Deblinger & Heflin, 1996)-in an attempt to improve treatment and outcomes for youth in foster care.

Methods: The project includes two phases: Phase 1: (a) preliminary feasibility study (N = 10) of the evidence-based engagement strategies and TF-CBT; and (b) refinement and development of a manualized engagement intervention based on feedback from foster parents and other key informants. Phase 2: pilot study (N=80) of the refined engagement strategies and TF-CBT (ECBT) compared to ‘usual practice’ TF-CBT (i.e., no specialized engagement) to assess implementation of the combined intervention and provide preliminary data on critical outcomes (e.g., PTS symptoms, behavioral problems, placement stability). Findings will be used to inform a large-scale randomized trial (i.e., R- 01) on effectiveness of ECBT to improve outcomes for youth in foster care with mental health problems. Youth in foster care have very high rates of mental health problems (Leslie, Hurlburt, Landsverk, & Barth, 2004). These include externalizing (e.g., conduct disorder, ADHD, oppositional defiant disorder) as well as internalizing (e.g., anxiety, depression, PTSD) problems. Recent research on epidemiology and treatment has suggested that this combination of symptoms is often related to youth in foster care’s extensive histories of exposure to trauma (Simms, Dubowitz, & Szilagyi, 2000) Therefore, effective treatment of the symptoms requires explicit evidence-based treatment that addresses both the underlying sequelae of trauma and the immediate behavioral manifestations. Trauma-focused Cognitive Behavioral Therapy (TF-CBT) is an evidence- based treatment that appears promising, with specific modifications, for this group of high-risk youth (Deblinger, Lippman, & Steer, 1996).

Implications: The proposed research builds from and combines existing evidence- based strategies (Cohen, Deblinger, Mannarino, & Steer, 2004; McKay, Stoewe, McDadam, & Gonzales, 1998) to more effectively treat some of the nation’s most at-risk and vulnerable youth. Findings from this research will be used to develop and disseminate more effective treatments for youth with mental health problems in the foster care system. Such findings should help improve treatment, services, and outcomes within the entire system of care that serves youth with mental health problems (e.g., specialty mental health providers, child welfare and child protective services, juvenile justice).

Principal Investigator: Shannon Dorsey (University of Washington)

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