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Predictive Associations Between Prenatal and Postnatal Risk Factors and Developmental and Temperamental Outcomes Among Infants in Foster Care

Infants detained for maltreatment present with a number of prenatal and perinatal risk factors, including prenatal exposure to substances, prematurity, low birth weight, birth complications, and prolonged hospital stay. These factors pose significant risk for a broad range of infant outcomes critically linked to later functioning, including cognitive, language, motor, socio-emotional, and temperamental development (Del Giudice, 2012; Singer et al., 2008). However, many infants exposed to prenatal risk also develop normatively, highlighting the need to better understand how the postnatal environment influences individual differences in response to prenatal risk. Importantly, prior to adoptive placement, infants placed in foster care often face unique stressors, including multiple foster placements and trial stays with birth families. Exposure to these pre-placement postnatal factors vary substantially across individuals, and they likely have unique and cumulative effects on developmental outcomes (Fisher et al., 2005; Waterman et al., 2013). Emerging evidence from normative samples suggests that prenatal and postnatal factors may interact to influence developmental outcomes, potentially through prenatal programming of infant responses to postnatal environments (Pluess & Belsky, 2011). These theoretical models have yet to be tested among infants in foster care, despite a need to better understand which prenatal and postnatal risk factors influence outcomes for these high-risk children. Thus, the present study aims to disentangle prenatal and postnatal risk factors to examine their unique and interactive associations with differentiated developmental outcomes (cognitive, language, motor, socioemotional) and early temperament among high-risk infants transitioning from foster care to adoption. Participants include 68 infants aged 0-28 months (race-ethnicity: 26% Hispanic, 14% African-American, 11% Caucasian, 1% Asian/Pacific Islander, 26% Mixed, 22% Unknown) referred for developmental assessment within two months of placement in adoptive homes. Prenatal/perinatal risk factors (prematurity, substance exposure, birth weight, birth complications, hospital stay) and postnatal risk factors (birth parent stay, age detained, number of placements, age at adoption) were coded from previous medical, DCFS, and court records. Infants were assessed using the Bayley Scales of Infant Development (BSID-III) to evaluate cognitive, motor (fine and gross), language (receptive and expressive), and socioemotional development. In addition, the primary adoptive parent completed the Infant/Toddler Temperament Questionnaire to measure temperament domains (e.g., sensitivity, reactivity, regularity). Preliminary correlations revealed that cognitive and motor development were most robustly associated with prenatal risk (i.e., prematurity, birth weight) and perinatal risk factors (i.e., birth complications, duration of hospital stay), whereas infant temperament domains were additionally linked to postnatal risk factors (i.e., birth parent placement, age detained, age of adoption, number of placements). Furthermore, differential associations between individual risk factors and outcomes were observed, suggesting there are likely unique risk factors predictive of different infant outcomes. Next, stepwise regressions will be employed to examine the independent, cumulative, and interactive associations between prenatal and postnatal risk factors on each developmental and temperamental outcome. Results will provide insight into the individual and cumulative effects of prenatal and preplacement postnatal risk factors for infants transitioning from foster care to adoption. Implications for key prevention and intervention targets among high-risk infants will be discussed.