P3B078: Developmental Characterization of Children in Foster Care

Background: In 2019, approximately 423,997 children were in foster care in the United States with >40% entering care between ages 0-5 years. Children in foster care are at greater risk for developmental delay compared to the general pediatric population. Inadequate surveillance, referral, and intervention during these formative years may negatively impact long-term outcomes. There is limited information characterizing the developmental profiles or trajectory of children in foster care. The objectives of this study were to characterize the developmental profile of children in foster care and compare differences in developmental trajectory to the general pediatric population.

Methods: A retrospective chart review was completed for children ages 9 to 48 months seen in a clinic serving as a medical home for children in foster care from May 2016 to May 2022. The comparison group included children who were not in foster care, seen in the co-located pediatrics clinic. Groups were matched for age at initial visit, sex, race, and ethnicity. Developmental profile was determined by Ages and Stages Questionnaire (ASQ-3) scores in five domains: Communication, Gross Motor, Fine Motor, Problem Solving and Personal-Social. Trajectory was determined through measuring progress across five developmental domains from at least three different points in time. Chart review data included biological conditions, environmental exposures, and interventions. Differences in developmental profile and trajectory were compared using chi square and mixed effects model analysis respectively. Raw domain scores were standardized through calculation of z-scores for each ASQ-3 age category using the study population.

Results: 397 patients were included with 205 in foster care and 192 in the comparison group. There were significant differences in rates of prematurity, mean birth weight and in-utero exposures (Table 1). The outcome proportions for categorical scores (delayed, borderline, normal) were significantly different between caregiver groups at initial visit for all developmental domains (p <.001). Children in the foster group were more likely categorized in the delayed/borderline range compared to the biological group. These differences persisted at follow-up visits. Mixed effects model analyses was used to come developmental trajectories between caregiver groups. There was a significant interaction between time and caregiver type (p <.001) in the Communication and Personal-Social domains. Scores for the foster care group were initially lower and steadily improved, versus the comparison group which showed higher and stable scores over time.

Conclusion: Children in the foster group had lower categorical and continuous ASQ-3 scores compared to the biological group. This difference was most notable in all developmental domains at the initial visit. This suggests that caregiver stability may result in better developmental outcomes. However, the developmental scores of the foster group did not catch-up to the biological group. Future analysis will correct for co-variables and consider the impact of interventions on developmental trajectory.