Nathan A. Fox

Growth and Associations Between Auxology, Caregiving Environment, and Cognition in Socially Deprived Romanian Children Randomized to Foster vs Ongoing Institutional Care

OBJECTIVES To determine effects of improved nurturing compared with institutional care on physical growth and to investigate the association between growth and cognitive development. DESIGN A randomized controlled trial beginning in infants (mean age, 21.0 months; range, 5-32 months), with follow-up at 30, 42, and 54 months of age. SETTING Institutionalized and community children in Bucharest, Romania. PARTICIPANTS One hundred thirty-six healthy institutionalized children from 6 orphanages and 72 typically developing, never-institutionalized children. INTERVENTION Institutionalized children were randomly assigned to receive foster care or institutional care as usual. OUTCOME MEASURES Auxology and measures of intelligence over time. RESULTS Growth in institutionalized children was compromised, particularly in infants weighing less than 2500 g at birth. Mean height and weight, though not head size, increased to near normal within 12 months in foster care. Significant independent predictors for greater catch-up in height and weight included age younger than 12 months at randomization, lower baseline z scores, and higher caregiving quality, particularly caregiver sensitivity and positive regard. Baseline developmental quotient, birth weight, and height catch-up were significant independent predictors of cognitive abilities at follow-up. Each incremental increase of 1 in standardized height scores between baseline and 42 months was associated with a mean increase of 12.6 points (SD, 4.7 points) in verbal IQ (P < .05). CONCLUSIONS Foster care had a significant effect on growth, particularly with early placement and high-quality care. Growth and IQ in low-birth-weight children are particularly vulnerable to social deprivation. Catch-up growth in height under more nurturing conditions is a useful indicator of caregiving quality and cognitive improvement.

Age of Assignment of Roles and Responsibilities to Children

Ethnographies of 50 cultures from the HRAF files were selected for exten-siveness of information about childhood. Ratings were made to estimate the ages at which each culture assumed responsibility or teachability in children or assigned a more mature social, sexual, or cultural role. The ratings were made in 27 categories. Inter-rater reliability averaged 63 % when calculated in a way that took into account failures to rate and disagreements about age, 84 % when calculated in a way that took into account only disagreements about age. Inspection of the 27 histograms obtained by this procedure suggested that for 16 of the 27 categories there appeared to be a modal cultural assignment of social responsibility in the 5- to 7-year age range. Four of the remaining eleven categories showed a mode at puberty, while the remaining seven seemed to be assigned across a broad age range. The inherent accuracy of the HRAF data demands cautious inference. Analysis of the data revealed that, in some respects at least, diverse human cultures assign new roles and responsibilities to children in the 5- to 7-year age range.