Author: Zach Morrow

Article Title: AIDS knowledge and HIV stigma among children affected by HIV/AIDS in rural China

Authors: Zhao Q1, Li X, Zhao G, Zhao J, Fang X, Lin X, Stanton, B.

Abstract: The current study was designed to assess the level of AIDS knowledge and its relationship with personal stigma toward people living with HIV/AIDS (PLWHA) among children living in communities of high HIV prevalence in rural China. The data were collected in 2009 from 118 orphanage orphans (children who had lost both of their parents to HIV and living in AIDS orphanages), 299 family-cared orphans (children who had lost one or both of their parents to HIV and living with surviving parents or extended families), 326 vulnerable children (children who were living with HIV-infected alive parents), and 276 comparison children (children from the same community who did not experience HIV-related illness and death in their family). Children were asked to answer 20 questions of AIDS knowledge. A 10-item stigma scale was employed to assess children’s own attitude toward PLWHA. Both bivariate and multivariate tests were performed to answer our research questions. The data in the current study demonstrate a relatively low percent of correct AIDS knowledge (60%) among samples. The comparison children reported the best score of AIDS knowledge and orphanage orphans scored the lowest. The children with better AIDS knowledge have less personal stigma toward PLWHA. The findings in the current study suggest the need of appropriate education strategies to provide AIDS knowledge to children, particularly for HIV-affected children living in communities of high HIV prevalence in rural China.

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Article Title: Perceived social support and psychosocial distress among children affected by AIDS in China

Authors: Hong Y, Li X, Fang X, Zhao G, Lin X, Zhang J, Zhao J, Zhang L

Abstract: The psychosocial wellbeing of the children affected by Acquired Immune Deficiency Syndrome (AIDS) receives growing international attention. However, limited data in this area are available in China, which hosts an estimate of 100,000 AIDS-orphaned children. The study aims to examine the relationship between perceived social support (PSS) and psychosocial wellbeing among children affected by AIDS. A cross-sectional survey was administered to 1,625 children (aged 6-18 years) in Henan Province, an area with a large number of HIV cases due to unhygienic commercial blood/plasma collection. Our sample included 296 double orphans (i.e., children who lost both parents to AIDS), 459 single orphans (children who lost one parent to AIDS), 466 vulnerable children (children living with HIV-infected parents) and 404 comparison children (children who did not experience HIV-related illness and death in family). Data suggest that vulnerable children reported the lowest level of PSS compared to AIDS orphans and comparison children. Level of PSS was significantly and positively associated with psychosocial wellbeing even after controlling for potential confounders. The study underscores the importance of providing social support and mental health services for children affected by AIDS in China.



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Article Title: A Caregiver-Child Social/Emotional and Relationship Rating Scale (CCSERRS)

Authors: Robert B. McCall, Christina J. Groark, and Larry Fish


This paper reports the construction and pilot reliability, validity, and psychometric properties of a new caregiver-child rating scale that emphasizes caregiver-child social-emotional interactions and relationships. While the scale was developed and studied in the context of orphanages for young children, it potentially could be used in non-residential early care and education settings as well as for parent-child interactions in the home. The intent was to assess a few dimensions that comprehensively cover the range of caregiver-child social-emotional interactions and relationships but could be administered in a relatively short period of time in a variety of situations and would not require extensive coder training, manuals, or materials. Results showed that the scale can be reliably administered even using observation periods as short as five minutes, reliability was replicated over seven different coders working in three different orphanages, and ratings of caregivers were similar across different types of caregiving activities (i.e., feeding, dressing/bathing, free play) and for caregivers attending to children birth to 4 and 4 to 8 yrs. of age. In the orphanage context, factor analyses showed the scale primarily reflects caregiver-child mutual engagement and relationship with subordinate components of caregiver punitiveness and caregiver- vs. child-directed behaviors and intrusiveness.

Early social/emotional relationship experiences, especially warm, caring, sensitive, and responsive interactions between adults and their infants and young children, are crucial contributors to promoting attachment (e.g., DeWolff & van IJzendoorn, 1997van IJzendoorn & Sagi, 1999), which in turn is associated with longer-term positive child outcomes in social and mental development (e.g.,Aviezer, Sagi, Resnick, & Gini, 2002Landry, Smith, & Swank, 2006;Landry, Smith, Miller-Loncar, & Swank, 1997Landry, Smith, Swank, & Miller-Loncar, 2000Steelman, Assel, Swank, Smith, & Landry, 2002). Social/emotional relationship experiences have also been associated with the quality of early care and education environments, early childhood developmental gains, and longer-term educational success (e.g., Edwards & Raikes, 2002Kontos, Howes, Shinn, & Galinsky, 1995).

Conversely, insecure attachment, especially disorganized attachment, is related to increased later problem behaviors, including externalizing behaviors in males and other social, behavior control, crime, and mental health problems, more so in high-risk children and those who continue to experience insensitive parenting and/or child care (e.g., Carlson, 1998Fonagy et al., 1997;Greenberg, 1999Lyons-Ruth, Alpern, & Repacholi, 1993Rothbaum & Weisz, 1994Shaw, Owens, Vondra, Keenan, & Winslow, 1997).

More specifically, institutional rearing environments for young children tend to provide quite minimal social/emotional relationship experiences (e.g., St. Petersburg-USA Orphanage Research Team, 20052008Rosas & McCall, 2008), and perhaps as a partial consequence of this deprivation such children tend to be substantially underdeveloped and have higher rates of behavioral problems even after being adopted into advantaged families (Blizzard, 1990Gunnar, 2001Johnson, 2000MacLean, 2003St. Petersburg-USA Orphanage Research Team, 20052008). Further, interventions that emphasize improved early social/emotional relationship experiences in orphanages (St. Petersburg-USA Orphanage Research Team, 2008Zeanah, Smyke, & Koga, 2003), provide high-quality foster care instead of institutionalization (Nelson, Zeanah, Fox, Marshall, Smyke, & Guthrie, 2007), or promote responsiveness in parents towards their own infants (Landry et al., 2006) have produced improvements in children’s development in several domains.

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Article Title: The Effects of Early Social-Emotional and Relationship Experience on the Development of Young Orphanage Children

Authors: The St. Petersburg—USA Orphanage Research Team

Abstract: Undertaken at orphanages in Russia, this study tests the role of early social and emotion experience in the development of children. Children were exposed to either multiple caregivers who performed routine duties in a perfunctory manner with minimal interaction or fewer caregivers who were trained to engage in warm, responsive, and developmentally appropriate interactions during routine care.  Engaged and responsive caregivers were associated with substantial improvements in child development and these findings provide a rationale for making similar improvements in other institutions, programs, and organizations.

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Article Title: Characteristics of children, caregivers, and orphanages for young children in St. Petersburg, Russian Federation

Authors: Rifkat J. Muhamedrahimov; Natalia V. Nikoforova; Oleg I. Palmov; Christina J. Groark; Robert B. McCall; Larry Fish

Abstract: This report provides baseline information on conditions in orphanages in the Russian Federation. This information addresses three major limitations in the literature on the development of children residing in substandard orphanages and those adopted from such environments. First, although there is an assumption that early exposure to substandard orphanages is associated with a variety of developmental delays during and after residency, there are essentially no comprehensive, empirical descriptions of what these early environments are like. This paper provides such information on the orphanage system in the Russian Federation and on a sample of children from 0–4 years of age residing in three orphanages in St. Petersburg. Second, because the orphanage environment is typically globally deficient, it is difficult to discern causal variables in developmental delays. In this report we attempt to show that the most salient deficiencies are in the social–emotional environment. Third, there are few empirical descriptions in the literature of the birth circumstances and characteristics of children residing in orphanages which make it difficult to untangle the relative contributions of poor perinatal circumstances and the orphanage environment in accounting for developmental delays. The results of this study show that a larger than expected number of orphanage children have poor perinatal circumstances, and most fall far below the average local Russian norms on physical, cognitive and psychosocial development.

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Article Title: Review: The consequences of early institutionalization: can institutions be improved? – should they?

Authors: Robert B. McCall


Background and scope

The focus of this review is on institutionalized children, one of the most inequitably and severely treated groups of children. Although institutions vary, many share some common characteristics, including large groups, high children:caregiver ratios, many and changing caregivers and caregiver-child interactions that lack warm, sensitive, contingently-responsive and child-directed behaviours. Resident children develop poorly physically, mentally and social-emotionally, but those adopted from institutions display substantial catch-up growth in many domains of development. If they are adopted at an early age, there have been no long-term consequences of institutionalization yet measured; but if institutionalization is prolonged, they display higher rates of long-term deficiencies and problems in many domains.


This review is based on a database search of the literature, focusing on the development of children while residents, and the development of post-institutionalized children who have been transitioned from institutions to family care. It also draws on the reports and findings of the St. Petersburg–USA Orphanage intervention.


A combination of theories pertaining to attachment (especially caregiver attachment to the infant–toddler), chronic stress and genetics may explain these outcomes. It appears that caregiver–child interactions are a major contributor to children’s outcomes and interventions in institutions that improve such interactions produce substantial increases in children’s physical, mental and social-emotional development, including for children with disabilities.


Deinstitutionalization and the creation of comprehensive professional child welfare systems emphasizing family care alternatives is a preferred goal, but this is likely to take many low-resource countries decades to develop. If substantial numbers of children remain in institutions despite best efforts to find families for them, improving the institutions might help to provide all the children with the best care possible under the circumstances.

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Article Title: Maintaining a Social-Emotional Intervention and Its Benefits for Institutionalized Children

Authors: Robert B. McCall, Christina J. Groark, Larry Fish, Rifkat J. Muhamedrahimov, Oleg I. Palmov and Natalia V. Nikiforova

Abstract: This article reports the maintenance of one of the largest interventions conducted in St. Petersburg (Russian Federation) orphanages for children birth to 4 years using regular caregiving staff. One orphanage received training plus structural changes, another training only, and a third business as usual. The intervention produced substantial differences between these institutions on the Home Observation for Measurement of the Environment (HOME) Inventory and on the Battelle Developmental Inventory scores for children. These institutional differences in HOME scores (= 298) and Battelle scores for children (= 357) departing the institutions for families in St. Petersburg and the United States were maintained for at least 6 years after the intervention project. This result may be associated with certain features of the intervention and activities conducted during the follow-up interval.

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Article Title: Inhibitory Control and Working Memory in Post-Institutionalized Children

Authors: Emily C. Merz, Robert B. McCall, Amanda J. Wright, Beatriz Luna

Abstract: Inhibitory control and working memory were examined in post-institutionalized (PI) children adopted into United States families from Russian institutions. The PI sample originated from institutions that were less severely depriving than those represented in previous studies and approximated the level of psychosocial deprivation, which is characterized by adequate physical resources but a lack of consistent and responsive caregiving. PI children (N = 75; 29 male) ranged in age from 8–17 years (M = 12.97; SD = 3.03) and were grouped according to whether they were adopted after 14 months or before 9 months. A non-adopted comparison group (N = 133; 65 male) ranged in age from 8–17 years (M = 12.26; SD = 2.75). PI children adopted after 14 months of age displayed poorer performance on the stop-signal and spatial span tasks relative to PI children adopted before 9 months of age after controlling for age at assessment. The two PI groups did not differ in their performance on a spatial self-ordered search task. Older-adopted PI children also showed poorer spatial span task performance compared to non-adopted children, but younger-adopted PI children did not. Task performance was significantly associated with parent-rated hyperactive-impulsive behavior in everyday contexts. These findings suggest that exposure to prolonged early institutional deprivation may be linked with inhibitory control and working memory difficulties years after adoption.

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Article Title: Potential Selective Responding in a Parent Questionnaire Study of Post-Institutionalized Children

Authors: Brandi N. Hawk, Amanda Wright, Megan M. Julian, Johana M. Rosas, Emily C. Merz & Robert B. McCall

Abstract: This study assesses selective responding in a single wave of data collection and a four-wave study. Participants were 121 parents of post-institutionalized children, identified as “never responders,” “previous responders,” or “wave 4 responders.” Parents evaluated their adopted child’s family, school, peer, and behavioral adjustment. Children (47% male) were 2 to 20 years old (M = 10.79, SD = 4.59) and adopted between 5 and 54 months of age (M = 15.49, SD = 9.94). Within a single wave of data collection, no evidence suggested that selective responding contributes much bias. Over a multi-wave study, however, results may under-represent adjustment difficulties.

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Study Title: Structure, caregiver–child interactions, and children’s general physical and behavioral development in three central American institutions

Authors: Groark, Christina J.; McCall, Robert B.; McCarthy, Stephanie K.; Eichner, Joan C.; Gee, Amy D.

Abstract: This article describes structural characteristics and caregiver–child interactions (N = 34) in three Central American institutions for infants and young children (N = 79) and relates differences in these characteristics to differences in children’s physical, behavioral, and cognitive development. Generally, the institution with the smallest group size, fewest children per caregiver, and a few consistent caregivers had children with the best physical, behavioral, and cognitive development; this institution also had many temporary volunteers who played with the children. Differences in the quality of caregiver–child interactions were not directly related to children’s development, but the potential benefit of high-quality interactions may have been minimized by a high children:caregiver ratio in one institution, and the presence of volunteers to play with children may have compensated for and/or minimized the display of higher-quality interactions by staff caregivers in another institution. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

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