Abstract
OBJECTIVE: This prospective longitudinal study of a general population sample investigates whether maternal experience of out-of-home care (OHC) constitutes an independent risk factor for the development of externalising and internalising symptoms in offspring, after adjusting for other commonly associated aetiologic risks. PARTICIPANTS: 18 810 families in the UK Millennium Cohort Study with complete information provided by the birth mother regarding her OHC experience and ethnicity. PRIMARY OUTCOME MEASURES: Offspring externalising and internalising symptoms assessed by the Strengths and Difficulties Questionnaire as reported by the birth mother. DESIGN: Latent profile analysis of offspring behavioural adjustment trajectories to identify distinct patterns of co-occurring internalising and externalising problem trajectories from age 3 to 17 years. The role of maternal OHC experience and other risk factors as predictors of adjustment patterns were examined descriptively and using multinomial regression. RESULTS: Five groups of symptom trajectories were identified: two normative groups with very low (33%) and low symptom levels (40%) and three problem behaviour groups including high externalising/moderate internalising (10%), high internalising/high externalising (5%) and moderate internalising/high externalising (12%). Compared with the normative group, higher symptoms were predicted by family socioeconomic status (SES), housing conditions, maternal health, parent-child relationship and child characteristics. Maternal OHC experience was a significant risk factor for all three problem groups, with the highest relative risk (RRR 4.82) observed for children showing high internalising/externalising symptoms. However, after controlling for the other risk factors, maternal OHC experience was no longer significantly associated with higher symptoms. CONCLUSION: Maternal OHC experience is associated with an elevated risk of offspring presenting adjustment problems, characterised by co-occurring internalising and externalising symptom trajectories. However, the impact of maternal OHC experience on their children's adjustment was fully attenuated by other common etiological risks, suggesting that these factors play a critical role in mediating the risk.