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BEHAVIOR PROBLEMS IN CHILDREN TRANSFERRED FROM A SOCIOEMOTIONALLY DEPRIVING INSTITUTION TO ST. PETERSBURG (RUSSIAN FEDERATION) FAMILIES RIFKAT J. MUHAMEDRAHIMOV AND VARVARA V. AGARKOVA

St. Petersburg State University ELENA A. VERSHNINA

Pavlov Institute of Physiology RAS, St. Petersburg OLEG I. PALMOV

St. Petersburg State University NATALIA V. NIKIFOROVA

Baby Home 13, St. Petersburg ROBERT B. MCCALL AND CHRISTINA J. GROARK

University of Pittsburgh Office of Child Development Behavior problems were studied in fifty 5- to 8-year-old children transferred from a socioemotionally depriving Russian institution to domestic families. Results indicated that the postinstitutional (PI) sample as a whole had higher clinical/borderline behavior problem rates on the parentreported Child Behavior Checklist for Ages 6–18 (T.M. Achenbach & L.A. Rescorla, 2001) aggressive and lower rates on the withdrawn/depressed and internalizing problems scales than did non-institutionalized (non-I) children reared in Russian families. Compared with the U.S. standardization sample, PI children had significantly higher rates for aggressive, externalizing, and social problems; the non-I children had higher rates for withdrawn/depressed and internalizing problems; and both groups had higher rates for rule-breaking behavioral problems. PI children placed in domestic families at 18 months or older had higher rates of problems than did the U.S. non-I standardization sample, but children placed at younger ages did not. PI children transferred to nonbiological families had lower rates of problems compared to U.S. norms than did children transferred to biological families. Thus, prolonged early socioemotional deprivation was associated with a higher percentage of behavior problems in children placed in domestic families, especially if transferred to biological families.

ABSTRACT:

Se estudiaron los problemas de conducta en 50 ni˜nos de 5 a 8 a˜nos de edad transferidos de una instituci´on rusa con privaci´on de aspectos socio-emocionales a familias dom´esticas. Los resultados indicaron que el grupo muestra post-institucional (PI), en su totalidad, present´o puntajes m´as altos de problemas de conducta cl´ınicos/fronterizos en el reporte CBCL de los padres (Achenbach y Rescorla, 2001), agresivos y m´as bajos puntajes en las escalas de problemas de introversi´on/depresi´on e internalizaci´on que los ni˜nos no institucionalizados (Non-PI) criados en familias rusas. En comparaci´on con el grupo muestra estandarizado de Estados Unidos, los ni˜nos PI ten´ıan m´as altos puntajes en problemas de agresividad, externalizaci´on y sociales; los ni˜nos Non-PI ten´ıan puntajes m´as altos en cuanto a problemas de introversi´on/depresi´on e internalizaci´on; y ambos grupos ten´ıan puntajes m´as altos en cuanto a problemas de violaci´on de reglas. Los ni˜nos PI colocados en familias dom´esticas a los 18 meses de edad o posteriormente ten´ıan m´as altos puntajes de problemas que los ni˜nos Non-PI del grupo muestra estandarizado de Estados Unidos, pero no fue el caso de los ni˜nos colocados a una edad menor. Los ni˜nos PI transferidos a familias no biol´ogicas ten´ıan m´as bajos puntajes de problemas comparados con las normas en los Estados Unidos que los ni˜nos transferidos a familias biol´ogicas. De manera que una privaci´on prolongada de aspectos socio-emocionales fue asociada con un m´as alto porcentaje de problemas de conducta en ni˜nos colocados en familias dom´esticas, especialmente si hab´ıan sido transferidos a sus familias biol´ogicas.

RESUMEN:

This research was supported by Grant HD050212 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to Robert B. McCall and Christina J. Groark. The authors thank the research team members in St. Petersburg who contributed to the data collection and the participating families who made this study possible. The authors also thank Maria Solodunova, and Daria Chernego for their assistance with the project management and data base. Direct correspondence to: Rifkat J. Muhamedrahimov, Department of Psychology, Naberezhnaya Makarova, 6, St. Petersburg State University, St. Petersburg, Russian Federation, 199034; e-mail: [email protected]. INFANT MENTAL HEALTH JOURNAL, Vol. 35(2), 111–122 (2014)  C 2014 Michigan Association for Infant Mental Health View this article online at wileyonlinelibrary.com. DOI: 10.1002/imhj.21435

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´ ´ RESUM E:

Les probl`emes de comportement ont e´ t´e e´ tudi´es chez 50 enfants de 5 a` 8 ans transf´er´es en familles d’accueil d’une institution russe ne les ayant pas d´evelopp´es du point de vue socio-´emotionnel. Les r´esultats ont indiqu´e que l’´echantillon post-institutionnel (PI) en tant que groupe avait des taux de probl`emes de comportement cliniques/borderline plus e´ lev´es sur la CBCL rapport´ee par les parents (Achenbach & Rescorla, 2001) Des taux aggressifs et moins e´ lev´es sur les e´ chelles retir´e/d´eprim´e et les e´ chelles de probl`emes d’internatilisation que les enfants non-institutionnalis´es (Non-PI) e´ lev´es dans des familles russes. Compar´es aux e´ chantillons de standardisation am´ericains, les enfants PI avaient des niveaux bien plus e´ lev´es pour les probl`emes d’agressivit´e, les probl`emes d’externalisation et les probl`emes sociaux. Les enfants Non-PI avaient des scores plus e´ lev´es pour les pour les probl`emes d’internationalisation et les probl`emes de d´epression. Les deux groupes avaient des niveaux plus e´ lev´es pour les probl`emes de comportement de d´efi aux r`egles. Les enfants PI plac´es en familles a` 18 mois ou plus avaient des incidences de probl`emes plus e´ lev´ees que l’´echantillon standard am´ericain Non-Pi, mais les enfants plac´es plus jeunes n’en avaient pas. Les enfants PI transf´er´es dans des familles non-biologiques avaient des incidences de probl`emes moins e´ lev´ees compar´es aux normes am´ericaines que les enfants transf´er´es dans des familles biologiques. Par cons´equent, la privation socio-´emotionnelle prolong´ee e´ tait li´ee a` un pourcentage plus e´ lev´e de probl`emes de comportement chez les enfants plac´es dans des familles, surtout s’ils e´ taient transf´er´es dans leurs familles biologiques. ZUSAMMENFASSUNG: Es wurden Verhaltensprobleme von f¨unfzig 5- bis 8-j¨ahrigen Kindern untersucht, die aus sozial- emotional benachteiligenden russischen Institutionen in Pflegefamilien vermittelt wurden. Die Ergebnisse zeigten, dass die Post-institutionelle (PI)-Stichprobe insgesamt h¨ohere Raten hinsichtlich klinischer/grenzwertiger Verhaltensprobleme (aggressives Verhalten) im von den Eltern berichteten CBCL (Achenbach & Rescorla, 2001) und niedrigere Raten f¨ur die Skalen sozialer R¨uckzug/Depressivit¨at und Internalisierungsprobleme hatte als nicht-institutionalisierte (Nicht -PI) Kinder, die in russischen Familien aufgewachsen sind. Im Vergleich mit der Normierungsstichprobe aus den USA hatten PI Kinder deutlich h¨ohere Raten f¨ur aggressive, Externalisierungs- und soziale Probleme, die Nicht-PI Kinder hatten h¨ohere Raten f¨ur sozialen R¨uckzug/Depressivit¨at und Internalisierungsprobleme. Des Weiteren zeigten beide Gruppen h¨ohere Raten f¨ur Verhaltensprobleme in Form von Regelverletzungen. PI Kinder, die mit 18 Monaten oder sp¨ater in die Pflegefamilien vermittelt wurden, hatten mehr Probleme als die Nicht-PI Normierungsstichprobe aus den USA, allerdings zeigten sich die Probleme nicht bei Kindern, die im j¨ungeren Alter vermittelt wurden. PI Kinder, die in nicht-biologischen Familien untergebracht wurden, hatten im Vergleich mit den USA-Normen geringere Probleme als Kinder, die in biologischen Familien untergebracht wurden. Folglich wurden l¨angere fr¨uhe sozial-emotionale Entbehrungen vor allem dann mit einem h¨oheren Prozentsatz an Verhaltensproblemen bei Kindern, die in Pflegefamilien platziert wurden, assoziiert, wenn die Kinder den biologischen Familien u¨ bergeben wurden. ABSTRACT: Behavior problems were studied in 50 5- to 8-year-old children transferred from a social-emotionally depriving Russian institution to domestic families. dd:ddddddddddddddddddddddddddddddd50dd5-8ddddddddddddddddddd dddddddd(PI)dddddddddddddddddddddddddddddddd(Non-PI)dddddddddddd dCBCL(Achenbach & Rescorla, 2001)dddddddddddddddd/dddddddddddddddd/dddddddddd ddddddddddddddddddddddddddddddPIdddddddddddddddddddddddddddd dddNon-PIddddddddddddddd/dddddddddddddddddddddddddddddddddddddd dddddddddddd18ddddddddddPIddddddddddddddNon-PIddddddddddddddddddd ddddddddddddddddddddddddddddddddddddddddddddPIddddddddddddddd dddddddddddddddddddddddddddddddddddddddddddddddddddddddddddd ddddddddddddddddddddddddddddddddddddddddddddddddddddddddddd

* * * Studies of behavioral functioning in children adopted from institutional care show that they are at higher risk for behavior problems than are nonadopted children reared by their biological parents and children adopted from non-institutional settings (Ames, 1997; Bruce, Tarullo, & Gunnar, 2009; Hawk & McCall, 2010, 2011; Juffer & van IJzendoorn, 2005; MacLean, 2003; Miller, Chan, Tirella, & Perrin, 2009; Pollak et al., 2010; Rutter, Kreppner, & O’Connor, 2001; Rutter et al., 2007). Data have suggested that behavioral functioning of children with institutional experience depends on the severity of deprivation (Hodges & Tizard, 1989a; Julian, 2013; Merz & McCall, 2010; Sonuga-Barke et al., 2008; Tizard & Hodges, 1978), timing of early institutionalization (Bruce et al., 2009; Camras, Chen, Bakeman, Norris, & Cain, 2006; Gunnar, 2001; Hawk & McCall, 2011; Kreppner et al.,

2007; MacLean, 2003; Merz & McCall, 2010; Rutter et al., 2010), age at assessment (Groza, Chenot, & Holtedahl, 2004; Groza & Ryan, 2002; Hawk & McCall, 2011; Merz & McCall, 2010; Verhulst, 2000), and characteristics of postinstitutional (PI) families (e.g., Hodges & Tizard, 1989b; Julian & McCall, 2011; Tizard & Hodges, 1978; Tizard & Rees, 1975). Some studies have suggested that placing institutionalized children into nonadoptive families may influence behavioral development (for a review, see Juffer & van IJzendoorn, 2005). For example, Zeanah et al. (2009) studied severely deprived, institutionalized Romanian children who were then reunified with biological parents and found that internalizing behaviors were reduced in young children. To date, there have been no studies on the behavioral functioning of children from psychosocially deprived institutions of

Infant Mental Health Journal DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.

Behavior Problems in Children

the Russian Federation placed into Russian families or on cultural factors that influence such children’s behavioral development. The aim of this study was to examine the behavior problems of children from an institution located in St. Petersburg (Russian Federation) who were then transferred to St. Petersburg PI families, as compared to non-I children from St. Petersburg families; both groups were compared to U.S. norms to provide some information on possible cultural differences. SEVERITY OF INSTITUTIONAL DEPRIVATION

Most institutions that are described in the literature do not provide environments that adequately promote children’s development (e.g., Rosas & McCall, 2011; van IJzendoorn, BakermansKranenburg, & Juffer, 2007), and they can be differentiated according to the severity of deprivation (Julian, 2013; Merz & McCall, 2010). “Globally depriving institutions” do not provide children with adequate medical care, nutrition, and sanitary, social, and psychological conditions (Gunnar, 2001; Rutter et al., 2007). Children spend most time in their cribs or cots, they do not have enough toys, and there is little one-to-one interaction with caregivers. In “socioemotionally depriving institutions,” children have adequate medical care and nutrition, but caregivers are businesslike and perfunctory when performing routine caretaking activities and do not provide much interaction with children (Gunnar, 2001; Muhamedrahimov, 2000; Rosas & McCall, 2011; St. Petersburg– USA Orphanage Team, 2005). Institutions in St. Petersburg for children 0 to 4 years of age are called Baby Homes (BHs) and are characterized by socioemotionally depriving conditions in which caregivers direct most of the interactions with children and display a very low level of sensitivity and responsiveness. Children have no opportunity to form close relationships with staff because caregivers care for 12 to 14 children at one time and because children periodically transfer to new groups with different caregivers and peers. Children potentially experience 60 to 100 different caregivers by 2 years of age (Muhamedrahimov, 2000; St. Petersburg–USA Orphanage Research Team, 2008). Children come to BHs because of parental financial inability to care for a child, the inability of the parents to behaviorally care for the child (e.g., due to parental drug and alcohol abuse, mental health problems, and other mental and behavioral incompetencies), parental unwillingness to rear a child with frank disabilities, and involuntary loss of parental rights because of abuse or neglect (St. Petersburg–USA Orphanage Research Team, 2005). Children sometimes are temporarily placed into BHs if parents want to take care of the child after solving some of these problems. Studies of parent-reported behavioral functioning of PI children adopted from various institutional environments have reported higher rates of behavior problems, especially attention, externalizing, internalizing, social, and autistic-like problems (Gunnar, 2001; MacLean, 2003; Juffer & van IJzendoorn, 2005). Children internationally adopted from qualitatively better orphanages tend to have moderate behavior and social problems and inat-

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tention/overactivity (Dalen, 2001; Tan, Marfo, & Dedrick, 2007, 2010). Those adopted from socioemotionally depriving institutions were reported to have more attention, externalizing, and peerrelations problems than were nonadopted children from workingclass English families (Hodges & Tizard, 1989a; Tizard & Hodges, 1978). Children adopted by U.S. families from institutions in the Russian Federation had higher rates of clinical/borderline scores on the Child Behavior Checklist for Ages 6–18 (CBCL/6–18; Achenbach & Rescorla, 2001) Attention Problems and Social Problems scales than did children adopted from institutions with various levels of deprivation, and lower rates of attention, social, thought, internalizing, and externalizing problems than did children adopted from globally deprived Romanian institutions (Merz & McCall, 2010). Poor birth status (low birth weight and prematurity) was not associated with behavior problems in this study. In comparison with the CBCL/6–18 standardization sample of non-I U.S. children (Achenbach & Rescorla, 2001), psychosocially deprived children had higher rates only on Externalizing and Attention Problems scales (Merz & McCall, 2010). The current study compares PI Russian children transferred to domestic families with non-I Russian children, and both groups are compared with the CBCL/6–18 standardization sample of U.S. non-I children. The comparison with Russian non-I children controls for background cultural factors in domestic families that may be different than those in the U.S. families; such factors should be revealed in comparisons between non-I Russian versus U.S. children. TIMING OF EARLY INSTITUTIONALIZATION

The age at adoption is often used as a surrogate for time in the institution, and the correlation is indeed quite high in Russian BHs (Hawk & McCall, 2010). Data on relations between age at adoption and behaviors of children in PI families sometimes have been inconsistent (e.g., Julian, 2013; Merz & McCall, 2010; Marcovitch et al., 1997; Weitzman, & Avni-Singer, 2005). Some studies have shown associations between the age at adoption and later behavioral functioning of PI children (e.g., Bruce et al., 2009; Camras et al., 2006; Gunnar, 2001; Hawk & McCall, 2011; Kreppner et al., 2007; Merz & McCall, 2010; Rutter et al., 2010) while others have not shown such associations (e.g., Juffer & van IJzendoorn, 2005; Miller et al., 2009; Rojewski, Shapiro, & Shapiro, 2000; Tizard & Hodges, 1978). The inconsistency in findings may be due to severity of institutional deprivation, age at the outcome assessments, and behavioral domains (Hawk & McCall, 2011; Julian, 2013). Between-studies comparisons have revealed that higher rates of behavioral problems occur for those adopted after 6 to 24 months than for earlier adoptees (Hawk & McCall, 2011; Julian, 2013). Children from globally depriving Romanian institutions internationally adopted after 6 months show a heightened risk of later behavioral problems than do those adopted before 6 months (Kreppner et al., 2007). Studies of the parent-reported behavioral functioning of children from socioemotionally depriving

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institutions of the Russian Federation adopted into advantaged American families have found that children adopted before 18 months had significantly lower problem scores than did children adopted after 18 months of age (Hawk & McCall, 2011; Merz & McCall, 2010). Later adopted children had more borderline/clinical scores on the CBCL/6–18 Attention, Social, Internalizing, and Externalizing Problem scales (Merz & McCall, 2010). In these studies, placement into families beyond a certain age was associated with a steplike increase in risk for later behavioral problems. The age at which a step occurred seemed to vary with the severity of the institutional deprivation, with a step at 6 months of age at adoption for globally deprived Romanian adoptees and at 18 months for socioemotionally deprived adoptees from Russian BHs (Hawk & McCall, 2011; Julian, 2013). There have been no data on the association of time in the institution on behavioral development of psychosocially deprived Russian children transferred to domestic families, a major purpose of the current study. AGE AT ASSESSMENT

Studies have shown that the level of behavior problems for PI children may increase from middle childhood to adolescence (Colvert et al., 2008; Groza, Chenot, & Holtedahl, 2004; Groza & Ryan, 2002; Gunnar, van Dulmen, & the International Adoption Project Team, 2007; Hawk & McCall, 2011; Julian, 2013; Merz & McCall, 2010; Verhulst & Versluis-den Bieman, 1995). In contrast, the meta-analysis found no differences in internalizing and externalizing behavior, but higher total behavior problem scores for younger (4–12 years) than for older (13–18 years) children (Juffer & van IJzendoorn, 2005). In studies of children older than 8 years, no differences were found in internalizing behavior between PI and non-I children (Goldney, Donald, Sawyer, Kosky, & Priest, 1996; Cederblad, Hook, Irhammar, & Mercke, 1999; Hoksbergen, Rijk, Van Dijkum, & Laak, 2004; Audet, Kurytnik, & LaMare, 2006; Merz & McCall, 2010). Romanian PI children had more CBCL/6– 18 internalizing and total problems at 17 to 37 months of age than did Canadian-born, nonadopted children (Fisher, Ames, Chisholm, & Savoie, 1997). The contradiction between findings was thought to be due to an Age at Assessment × Age at Adoption interaction (Hawk & McCall, 2011; Merz & McCall, 2010). Children internationally adopted from socioemotionally depriving Russian institutions after 18 months had higher problem scores when assessed at 12 to 18 years than at 6 to 11 years (Hawk & McCall, 2011). To date, there has been no information on whether PI children transferred into Russian families will show the same Age at Assessment × Age at Adoption interaction for behavioral problems. PI FAMILY CHARACTERISTICS

Some studies have explored differences in children’s development as a function of the nature of the PI environment. Researchers have derived main characteristics of families that influence child’s development: stability of placement (Berrick, Barth, & Needell, 1994;

Brown, Cohon, & Wheeler, 2002; Testa, 1997), socioeconomic status (e.g., Colombo, de la Parra, & Lopez, 1992; Duyme, Dumaret, & Tomkiewicz, 1999), and the presence/absence of abuse and neglect in PI families (Barth & Berry, 1994; Farmer, 1996; Runyan & Gold, 1985; Terling, 1999; Wald, Carlsmith, & Leiderman, 1988). Adoptive homes can be considered to be the most appropriate environment for a child’s development while restored and kinship families may be less appropriate. At older ages, parent-reared and adopted children have less behavior problems than do institutionalized and reunified children (Hodges & Tizard, 1989b; Tizard & Hodges, 1978; Tizard & Rees, 1975). CURRENT STUDY

In the current study, we examined behavior problems in 5- to 8year-old children transferred to nonbiological (NBF) or biological families (BF) from one typical St. Petersburg institution for young children (BH). This BH belongs to the system of medical care and is characterized by adequate physical resources, but socioemotional deficiencies involving businesslike and perfunctory routine caretaking activities (St. Petersburg–USA Orphanage Research Team, 2005). Caregivers do not provide much interaction with children; they rarely initiate social interactions, respond to infants’ social bids, respond promptly to emotional distress, or provide warmth and affection. This BH had no intervention and conducted business as usual, and was the control condition in a large intervention study (St. Petersburg–USA Orphanage Research Team, 2005, 2008). We focused on parent-reported CBCL/6–18 scales and posed several questions. First, we examined whether children transferred from the institution to the group of domestic PI families (includes guardianship, foster care, adoption, kinship, and reunified families of biological parents) differed in behavior problems as compared to non-I Russian children. This comparison controls for cultural factors that would be assumed to be similar in these two groups of families. Second, we examined whether children transferred from the institution to domestic PI families and never-institutionalized children from St. Petersburg families differed in behavior problems as compared to non-I, parent-reared U.S. children in the CBCL/6– 18 standardization sample. PI children in Russian families might display different behaviors relative to the standardization sample of U.S. children, reflecting both institutional and Russian childrearing experience, while never-institutionalized children from Russian families might show behaviors different relative to the U.S. standardization sample, reflecting differences in child-rearing culture in Russia and in the United States. Third, we investigated the extent to which age at departure from Russian institutions was associated with behavior problems of children in domestic PI families. This might tell us if the risk of behavioral problems increases after 18 months of age at adoption for children placed in Russian as well as U.S. families. The group of PI-NBF consists of adoptive, nonrelative guardianship and foster care families, and BF include reunified

Infant Mental Health Journal DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.

Behavior Problems in Children

families of biological parents and kinship families. The majority of kinship caregivers are grandparents, with characteristics close to reunified families: lack of financial and social support, health problems, history of addictive behavior, and so on. Despite the possible BF risk factors, the state policy of the Russian Federation is largely directed at prevention of social orphanhood by keeping children in their biological families. When parents or relatives periodically visit a child in the institution, welfare specialists check to determine some improvement in family environment and prefer that the child be reunified or transferred from the institution to relatives. This study tests for possible differences in children’s behavior problems as a function of whether the children were transferred into PI-NBF or PI-BF.

METHOD Participants

Participants were 50 children (19 male, 31 female) with and without institutional experience living in families located in St. Petersburg. PI children (N = 31) were 5 to 8 years of age at assessment, M (SD) = 6.4 (1.0), from several days old to 49 months of age at institution intake, M (SD) = 16.2 (14.3), 6 to 60 months of age at departure, M (SD) = 30.2 (16.2), and 4 to 34 months in residence in the institution, M (SD) = 14.0 (7.9). Children who were transferred from the BHs back to BF or relatives (PI-BF group: n = 10; 2 boys, 8 girls) were 0 to 49 months of age at intake, M (SD) = 18.4 (16.2), 12 to 56 months old at departure, M (SD) = 31.9 (13.9), and 4 to 29 months in residence in the institution, M (SD) = 13.5 (7.8). Those transferred to NBF (PI-NBF group: n = 21; 7 boys, 14 girls) were 0 to 41 months of age at intake, M (SD) = 15.1 (13.6), 6 to 60 months old at departure, M (SD) = 29.4 (17.4), and 4 to 34 months in residence in the institution, M (SD) = 14.2 (8.1). Years in the family ranged from 1.7 to 6.7 years for the PI group, M (SD) = 3.9 (1.1), from 1.7 to 6.3 years for the PI-NBF group, M (SD) = 3.7 (1.1), and from 2.8 to 6.7 years for the PI-BF group, M (SD) = 4.1 (1.1). Characteristics of the PI combined, PI-NBF, PI-BF, and non-I groups are given in Table 1. The non-I group consisted of 5- to 8-year-old children, M (SD) = 6.4 (1.0) (10 male, 9 female) born in St. Petersburg who lived with their BF from birth and did not have institutionalization experience. Most PI families (53.3%; 66.7% of PI-NBF, and 30.0% of PI-BF) and 84.2% of non-I families had a two-parent household. The mean household income (converted from Russian Federation rubles to U.S. dollars) was $8,000 to 16,000 for the PI group ($8,000–16,000 in PI-NBF; $8,000–12,000 in PI-BF), and $8,000– 12,000 in the non-I group. Of PI caregivers, 58.1% (71.4% of PI-NBF and 30.0% of PI-BF) had at least 4 years of college, as compared to 42.1% of the non-I mothers. All parents were Russianspeaking and Caucasian. Thus, about half of the PI children were living in one-parent households (mostly because of single parents in BF), and parents in PI-NBF families had more years of education than did parents in PI-BF and better yearly family income than did parents in both PI-BF and non-I families (see Table 1).

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Procedure

This study is part of the larger St. Petersburg–USA Orphanage Research Team project. During the project, 66 children left the BHs and went to different types of families. Some data on PI children were gathered by staff of the BHs and by assessors of the project during home visits of the families. To organize family visits, social workers for the BHs succeeded in connecting with families of 56 children (85%), 8 additional families moved, and 2 families changed their telephone number. Of the 56 families, 9 refused to participate in the project, 11 had children who were out of the 5- to 8-year-old range for this study, and an appointment could not be made with 5 additional families. For non-I families, a description of the project was available from information desks of St. Petersburg well-baby clinics. Seventy-four non-I families applied to participate in the project, and 19 (26%) children were the proper age for this study. PI and non-I children and their parents (mostly mothers) were visited by two assessors from the research team and offered a consent form and a battery of numerous assessments, including a form for the children’s background, family life conditions, and the CBCL/6–18. During the home visit, one assessor conducted assessments of the child, and another assessor presented the battery of forms to the parent.

Measures

The CBCL/6–18 (Achenbach & Rescorla, 2001). On this Checklist, parents report the extent to which each of 113 listed behaviors is true of their child on a Likert scale of 0 (not true), 1 (somewhat or sometimes true), and 2 (very true or often true). The CBCL/6–18 has eight narrow-band subscales, two broadband scales, and a Total Problem scale. The Total Problem scale consists of 113 items. The broadband Internalizing Problem scale consists of anxious/depressed (13 items), withdrawn/depressed (8 items), and somatic complaints (11 items); the broadband Externalizing Problem scale consists of rule-breaking behavior (17 items) and aggressive behavior (18 items). Three other subscales (Attention Problems: 10 items, Social Problems: 11 items, and Thought Problems: 15 items) fit neither the Externalizing nor the Internalizing scales. Because the CBCL/6–18 items differed little from those of the CBCL/4–18 (Achenbach, 1991), it was used to assess children from 5 years of age (Gunnar, 2007). The CBCL/6–18 has well-documented reliability and validity for assessing problem behaviors among nonadopted as well as adopted children from various ethnic backgrounds (Crijnen, Achenbach, & Verhulst, 1999; Groza & Ryan, 2002; Gunnar, 2007; Liu et al., 1999; Mattison & Spitznagel, 1998; Merz & McCall, 2010; Verhulst, Althaus, & Versluis-den Bieman, 1990; Weine, Philips, & Achenbach, 1995). For 17 PI and non-I cases with isolated instances of missing CBCL/6–18 data, the average of the subscale to which the missing item belonged was calculated, rounded to the nearest whole number (0, 1, or 2), and then entered in place of the missing item.

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TABLE 1. Descriptive Data on Postinstitutional (PI Combined, PI-NBF, PI-BF) and Non-Institutional (Non-I) Children PI Groups Group Characteristics N Boys/Girls M (SD) Age at BH Intake (months) M (SD) Age at BH Departure (months) M (SD) Length in BH Residence (months) M (SD) Years in Postinstitution Family (years) M (SD) Age at Assessment (years) Two-Parent Household Parents With College Degree or More Yearly Family Income

PI Combined

PI-NBF

PI-BF

Non-I Group

31 9/22 16.2 (14.3) 30.2 (16.2) 14.0 (7.9) 3.9 (1.1) 6.4 (1.0) 53.3%∗ 58.1% $8.000–16.000

21 7/14 15.1 (13.6) 29.4 (17.4) 14.2 (8.1) 3.7 (1.1) 6.2 (0.9) 66.7% 71.4%∗∗ $12.000–16.000∗∗∗

10 2/8 18.4 (16.2) 31.9 (13.9) 13.5 (7.8) 4.1 (1.1) 6.8 (1.0) 30.0%† 30.0% $8.000–12.000

19 10/9 – – – – 6.4 (1.0) 84.2% 42.1% $8.000–12.000

BF = biological family; NBF = nonbiological family. ∗ p < .05 from Non-I. ∗∗ p < .05 from PI-BF. ∗∗∗ p < .05 from PI-BF and Non-I. † p < .01 from Non-I.

Age at transition from BH to PI family. Date of departure was registered by staff at the BHs in their records, which also included the child’s birth date, date of intake to the BH, and date of transition to the family; the home visitor recorded the date of the assessment. These dates were used to calculate the age of the child at each of these points and the total length of residency in the institution. Age at departure from a BH to the family was strongly correlated with age at intake, r = 0.88, p < .001, n = 31, time in the institution, r = 0.45, p < .01, n = 31, age at assessment, r = 0.57, p < .001, n = 31, and time in the PI family, r = −0.70, p < .001, n = 31. Age at departure from the the BH was used in analyses because it is the measure of actual age at transition to the PI family, which is used frequently in studies of PI adopted children. The PI, PI-NBF, and PI-BF children were grouped into those who were 18 (n = 14)

χ 2 (1, n = 21)

% < 18 (n = 2)

% > 18 (n = 8)

χ 2 (1, n = 10)

0 11.1 0 22.2 11.1 22.2 33.3 11.1 0 11.1 0

13.6 27.3 22.7 40.9 18.2 27.3 36.4 40.9 13.6 45.5 27.3

1.36 0.95 2.44 0.97 0.24 0.09 0.03 2.60 1.36 3.29 3.04

0 14.3 0 28.6 14.3 14.3 18.6 14.3 0 0 0

7.1 21.4 21.4 28.6 14.3 21.4 21.4 35.7 7.1 42.9 21.4

0.53 0.15 1.75 0.00 0.00 0.15 0.13 1.05 0.53 4.20∗ 1.75

0 0 0 0 0 50 50 0 0 50 0

25 37.5 25 62.5 25 37.5 62.5 50 25 50 37.5

0.63 1.07 0.63 2.50 0.63 0.10 0.10 1.67 0.63 0.00 1.07

Bold percentages are significantly higher than the CBCL/6–18 standardization sample rate (14%; n = 438). ∗ р < .05.

Specifically, non-I Russian children had significantly higher rates for rule-breaking than did the U.S. norms, and higher rates for the Withdrawn/Depressed and Internalizing Problems scales than did both the U.S. standardization sample and the combined PI group transferred to Russian families. The low rates for the Withdrawn/Depressed and Internalizing Problems scales in PI children were mostly associated with children in NBF, which have higher family incomes and better parental education. At the same time, the higher rates on these three scales for non-I Russian children could be connected with their early caregiver–child interaction and attachment experience. Specifically, a separate study of the St. Petersburg infants living in low-risk families showed that within the ABCD attachment coding system (Ainsworth, Blehar, Waters, & Wall, 1978; Main & Solomon, 1990), half the children had secure B, insecure resistant

C, or insecure avoidant A attachment patterns, and half were rated as disorganized (Pleshkova & Muhamedrahimov, 2010). Using the dynamic maturational model classificatory method (Crittenden, 2000; Spieker & Crittenden, 2010), those family infants who were coded according to the ABCD system as disorganized showed the complex strategies of adaptation to the caregiving environment: namely, aggressive and feigned helpless (pre-С3–4), compulsive caregiving and compliant (pre-A3–4), and a combination of two strategies for adapting to their social environment (A/C) (Pleshkova & Muhamedrahimov, 2010). One could assume that for never-institutionalized Russian children, the insecure and complex C strategies in infancy results at older ages in parents reporting high rates of CBCL rule-breaking while the insecure and complex A strategies show up as withdrawn/depressed and internalizing problems.

Infant Mental Health Journal DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.

Behavior Problems in Children

PI children displaying higher rates of social problems, rulebreaking behavior, aggressive behavior, and externalizing were mostly those who spent more time in the institutional environment and were transferred to families after age 18 months. These results are consistent with findings of positive associations between age at adoption and behavioral problems in PI children adopted into British and U.S. families (Bruce et al., 2009; Camras et al., 2006; Gunnar, 2001; Hawk & McCall, 2011; Kreppner et al., 2007; Merz & McCall, 2010; Rutter et al., 2010). Given the differences in the age at assessment between this study (5–8 years) and the study of PI children adopted by U.S. families (6–18 years; Merz & McCall, 2010), it may be that higher rates of the behavioral problems occur somewhat earlier in Russian families than they do in the U.S. advantaged adoptive families. Within domestic families, children at the age of 18 months or older reunified with their BF families appeared to be at especially high risk for social, rule-breaking, aggressive, and externalizing problems (50–62.5%). This could suggest that the age when PI children demonstrate high rates of behavioral problems depends on characteristics of the PI families as well. State policy of the Russian Federation in recent years largely has been directed at prevention of social orphanhood by keeping children in parental families, decreasing the number of institutions, and placing orphans and children left without parental care in different types of domestic substitute families (guardianship, foster care, kinship, and adoptive families). In accordance with this policy, for the period from 2005 to 2010, the number of children under 18 years in all institutions decreased from 372,800 to 305,700 while the number of children in the care of foster parents and guardians increased from 390,500 to 430,600. For the period from 2005 to 2011, the number of children in the healthcare-system orphanages for children from birth to 4 years (BHs) decreased by 20% (from 20,621 in 254 BHs in 2005 to 16,296 children in 218 BHs in 2011). During this same period, the number of international adoptions of children from Russia decreased to 3,400 while the number of children placed for adoption in Russian families in 2011 was approximately 7,400 (The Transformative Monitoring for Enhanced Equity Database, 2013). After the passage in 2008 of the Federal law “On Guardianship and Custody,” (Federal Law of the Russian Federation, 2008), approximately 80% of children who came to be without parental care during the year were placed in families. The substantial shift from institutionalization to family care revealed the complexity of adaptation to families of children with long periods of institutionalization. A large number of children were returned from families back to institutions—approximately 12% in 2009 and 15% in 2010. A large number of returns were older children who had a long history of living in institutions and transferred to families after the age of 4 years. Approximately 70% of these returns were initiated by the parents, and the remainder was associated with improper caregiving in the families. It is obvious that the substitute parents are faced with considerable difficulty, and many were not prepared to foster children with significant behavioral and mental health problems because of their long-term institutional experience. Until the new substitute family system

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is better developed and professionally supported, institutions may remain a place where orphan children and children left without parental care can get social, medical, and pedagogical services. Conversely, the situation is better in Russian adoptive families. The rate of returns of adopted children is much less (2% in 2010), which could reflect the deliberate decision of adopted parents to raise the child, better preparation of such parents, and the fact that they tend to adopt much younger children who are exposed for a shorter time to the institutions. From a future policy standpoint, substitute parents need better preparation plus follow-up supervision. Special attention should be paid to those PI families who receive children older than 18 months. Reunification of institutionalized children with the BF implies either return to their biological parents or grandparents and relatives who may still be at risk. They, too, need supervision and support. The number of children living in institutions of the Russian Federation is still significant, and to reduce the intensity of behavioral problems in children, we suggest changes in the socioemotional environment in institutions aimed primarily at providing children sensitive, responsive, and consistent caregiving (St. Petersburg–USA Orphanage Research Team, 2008). As discussed in the 2013 draft of the governmental regulation “On Arrangement of Orphans and Children Left Without Parental Care in Institutions” (Draft Decree of the Government of the Russian Federation, 2013) these recommendations submitted by the St.Petersburg members of the research group have been accepted, and we hope that they will be included into the final version of the regulation. This study had a number of limitations. First, this report represents an analysis of a much larger intervention study designed and executed for other reasons, not specifically as a test of the behavior problems in children transferred from Russian BHs to domestic families. Second, the groups of children were small, making results less generalizable to larger populations of Russian PI and non-I children. Third, the CBCL/6–18 is a parent-report measure, which leaves open the possibility of rater bias, although studies have shown high correlations between both parent reports (Gunnar et al., 2007) and teacher reports (Miller et al., 2009). Fourth, there are no Russian CBCL/6–18 standardization norms, so the U.S. norms were used. Fifth, only 53% of children who left the BHs and went to different types of families were assessed, but 85% agreed to participate, which is higher than the 40 to 50% of the response rates for some studies of children adopted to U.S. families (Merz & McCall, 2010).

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