Are There Biological Programming Effects for Psychological Development? Findings From a Study of Romanian Adoptees

Effects of Mineralocorticoid Receptor Overexpression on Anxiety and Memory after Early Life Stress in Female Mice

Early-life stress (ELS) is a risk factor for the development of psychopathology, particularly in women. Human studies have shown that certain haplotypes of NR3C2, encoding the mineralocorticoid receptor (MR), that result in gain of function, may protect against the consequences of stress exposure, including childhood trauma. Here, we tested the hypothesis that forebrain-specific overexpression of MR in female mice would ameliorate the effects of ELS on anxiety and memory in adulthood. We found that ELS increased anxiety, did not alter spatial discrimination and reduced contextual fear memory in adult female mice. Transgenic overexpression of MR did not alter anxiety but affected spatial memory performance and enhanced contextual fear memory formation. The effects of ELS on anxiety and contextual fear were not affected by transgenic overexpression of MR. Thus, MR overexpression in the forebrain does not represent a major resilience factor to early life adversity in female mice.

Trauma- and Stressor-Related Disorders Among Children and Adolescents

DSM-5 introduced a clustering of disorders designated "trauma- and stressor-related disorders." These disorders are unique in that the etiology is specified as part of the diagnostic criteria. In this review, the authors consider how some of these disorders manifest for children and adolescents. In posttraumatic stress disorder and related disorders, the child is exposed to one or more frightening, traumatic events. In attachment disorders, the child experiences severe social neglect. With this framework in mind, the authors consider details of several prominent trauma- and stressor-related disorders that arise in response to either excessive, unwanted input or inadequate, necessary input among children and adolescents.

Early Adverse Experiences and the Developing Brain

Children exposed to various forms of adversity early in life are at increased risk for a broad range of developmental difficulties, affecting both cognitive and emotional adjustment. We review a growing body of evidence suggesting that exposure to adverse circumstances affects the developing brain in ways that increase risk for a myriad of problems. We focus on two forms of adversity, one in which children are exposed to childhood maltreatment in family environments, and another in which children are exposed to extreme psychosocial deprivation in contexts of institutional rearing. We discuss ways in which each of these experiences represent violations of species-expected caregiving conditions, thereby imposing challenges to the developing brain. We also review emerging data pointing to the effectiveness of early intervention in remediating neurodevelopmental consequences associated with maltreatment or institutional rearing. We conclude by discussing implications of this work for public health efforts and highlight important directions for the field.

Adoptive parenting and attachment: association of the internal working models between adoptive mothers and their late-adopted children during adolescence

INTRODUCTION

Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs) of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children, previously maltreated and neglected. While most research on adoptive families focused on pre-school and school-aged children, the aim of this study was to assess the concordance of IWMs of attachment in adoptive dyads during adolescence.

METHOD

Our pilot-study involved 76 participants: 30 adoptive mothers (mean age = 51.5 ± 4.3), and their 46 late-adopted adolescents (mean age = 13.9 ± 1.6), who were all aged 4-9 years old at time of adoption (mean age = 6.3 ± 1.5). Attachment representations of adopted adolescents were assessed by the Friend and Family Interview (FFI), while adoptive mothers' state-of-mind with respect to attachment was classified by the Adult Attachment Interview (AAI). Adolescents' verbal intelligence was controlled for.

RESULTS

Late-adopted adolescents were classified as follows: 67% secure, 26% dismissing, and 7% preoccupied in the FFI, while their adoptive mothers' AAI classifications were 70% free-autonomous, 7% dismissing, and 23% unresolved. We found a significant concordance of 70% (32 dyads) between the secure-insecure FFI and AAI classifications. Specifically adoptive mothers with high coherence of transcript and low unresolved loss tend to have late-adopted children with high secure attachment, even if the adolescents' verbal intelligence made a significant contribution to this prediction.

DISCUSSION

Our results provides an empirical contribution to the literature concerning the concordance of attachment in adoptive dyads, highlighting the beneficial impact of highly coherent states-of-mind of adoptive mothers on the attachment representations of their late-adopted adolescent children.

Adversity and Adjustment in Children in Institutions, Family Foster Care, and Adoption

This study's objective was to identify the adversity profiles of children in different childcare placements, and to analyze their relationship with subsequent psychological adjustment. We studied a group of 230 children 4 to 10 years old indifferent childcare placements (international adoption, institutional care, non-kin foster care, and kinship care), as well as a control group. Information was collected from parent or caregiver interviews and the Strengths and Difficulties Questionnaire (SDQ). The results showed that children in the child welfare system had experienced significant adversity before their current placement, especially among institutional care cases and international adoptees. Meanwhile, children in kinship care had experienced less adversity (p .50 to d > .80). After a period of time in their respective placements, children's psychological adjustment was generally positive, but children living in institutional care exhibited the most problems and difficulties, followed by non-kin foster care cases (p .50 to d > .80). Finally, we found that children's early adversity levels (p < .05; r = .16), age of current placement (p < .01; r = .23), and duration of current placement (p < .05: r = -.19) were all tied to current psychological adjustment.

Neural plasticity and the development of attention: Intrinsic and extrinsic influences

The development of attention has been strongly linked to the regulation of emotion and behavior and has therefore been of particular interest to researchers aiming to better understand precursors to behavioral maladjustment. In the current paper, we utilize a developmental psychopathology and neural plasticity framework to highlight the importance of both intrinsic (i.e., infant neural functioning) and extrinsic (i.e., caregiver behavior) factors for the development of attentional control across the first year. We begin by highlighting the importance of attention for children's emotion regulation abilities and mental health. We then review the development of attention behavior and underscore the importance of neural development and caregiver behavior for shaping attentional control. Finally, we posit that neural activation associated with the development of the executive attention network may be one mechanism through which maternal caregiving behavior influences the development of infants’ attentional control and subsequent emotion regulation abilities known to be influential to childhood psychopathology.

Institutional care and iron deficiency increase ADHD symptomology and lower IQ 2.5-5 years post-adoption

Increased ADHD symptomology and lower IQ have been reported in internationally adopted (IA) children compared to non-adopted peers (Hostinar, Stellern, Schaefer, Carlson & Gunnar, 2012; Kreppner, O'Connor & Rutter, 2001). However, it is unclear whether these outcomes are due to institutional deprivation specifically or to co-occurring micronutrient deficiencies that disrupt brain development (Fuglestad, Rao & Georgieff, 2008b). In this study, IA children were compared to children raised in their biological families to examine differences in ADHD symptomology and IQ 2.5-5 years post-adoption and to assess the contributions of iron deficiency (ID) and duration of deprivation to these cognitive outcomes. ADHD symptoms (parent- and experimenter-reported) and IQ were evaluated in 88 IA (M = 62.1 months, SD = 2.4) and 35 non-adopted children (M = 61.4 months, SD = 1.6). IA children were assessed 29-64 months post-adoption (M = 41.9 months, SD = 10.2). ID was assessed during the initial post-adoption medical visit in 69 children, and children were classified into four groups by iron status, ranging from normal to ID anemia (most severe). IA children had greater ADHD symptomology, p < .01, and lower IQ, p = .001, than non-adopted children. Within the IA group, children with more severe ID at adoption had greater ADHD symptomology, r(69) = 0.40, p = .001, and lower IQ, r(68) = -0.28, p < .05. Duration of institutional care was positively correlated with ADHD symptoms, r(86) = .28, p < .01, but not IQ, r(85) = -.08, p = .52. Longitudinal results indicate improvement in IQ from 12 months post-adoption to age 5 for children with greater ID severity at adoption and longer duration of institutional care but no improvement in ADHD symptoms. These results signify continuing effects of early deprivation and ID on ADHD symptoms and IQ years after adoption. A video abstract of this article can be viewed at http://www.youtube.com/watch?v=vUFDAS3DD1c.

Annual research review: Attachment disorders in early childhood--clinical presentation, causes, correlates, and treatment

BACKGROUND

Though noted in the clinical literature for more than 50 years, attachment disorders have been studied systematically only recently. In part because of the ubiquity of attachments in humans, determining when aberrant behavior is best explained as an attachment disorder as opposed to insecure attachment has led to some confusion. In this selective review, we consider the literature on reactive attachment disorder and disinhibited social engagement disorder and describe an emerging consensus about a number of issues, while also noting some areas of controversy and others where we lack clear answers. We include a brief history of the classification of the disorders, as well as measurement issues. We describe their clinical presentation, causes and vulnerability factors, and clinical correlates, including the relation of disorders to secure and insecure attachment classifications. We also review what little is known and what more we need to learn about interventions.

METHODS

We conducted a literature search using PubMed, PsycINFO, and Cochrane Library databases, using search terms 'reactive attachment disorder,' 'attachment disorder,' 'indiscriminate behavior,' 'indiscriminate friendliness,' 'indiscriminate socially disinhibited reactive attachment disorder,' 'disinhibited social engagement disorder,' and 'disinhibited social behavior.' We also contacted investigators who have published on these topics.

FINDINGS

A growing literature has assessed behaviors in children who have experienced various types of adverse caregiving environments reflecting signs of putative attachment disorders, though fewer studies have investigated categorically defined attachment disorders. The evidence for two separate disorders is considerable, with reactive attachment disorder indicating children who lack attachments despite the developmental capacity to form them, and disinhibited social engagement disorder indicating children who lack developmentally appropriate reticence with unfamiliar adults and who violate socially sanctioned boundaries.

CONCLUSIONS

Although many questions remain to be answered, especially regarding appropriate interventions, we know considerably more about attachment disorders than we did only a decade ago.

Easy to remember, difficult to forget: the development of fear regulation

Fear extinction learning is a highly adaptive process that involves the integrity of frontolimbic circuitry. Its disruption has been associated with emotional dysregulation in stress and anxiety disorders. In this article we consider how age, genetics and experiences shape our capacity to regulate fear in cross-species studies. Evidence for adolescent-specific diminished fear extinction learning is presented in the context of immature frontolimbic circuitry. We also present evidence for less neural plasticity in fear regulation as a function of early-life stress and by genotype, focusing on the common brain derived neurotrophin factor (BDNF) Val66Met polymorphism. Finally, we discuss this work in the context of exposure-based behavioral therapies for the treatment of anxiety and stress disorders that are based on principles of fear extinction. We conclude by speculating on how such therapies may be optimized for the individual based on the patient's age, genetic profile and personal history to move from standard treatment of care to personalized and precision medicine.

Early-life experience, epigenetics, and the developing brain

Development is a dynamic process that involves interplay between genes and the environment. In mammals, the quality of the postnatal environment is shaped by parent-offspring interactions that promote growth and survival and can lead to divergent developmental trajectories with implications for later-life neurobiological and behavioral characteristics. Emerging evidence suggests that epigenetic factors (ie, DNA methylation, posttranslational histone modifications, and small non-coding RNAs) may have a critical role in these parental care effects. Although this evidence is drawn primarily from rodent studies, there is increasing support for these effects in humans. Through these molecular mechanisms, variation in risk of psychopathology may emerge, particularly as a consequence of early-life neglect and abuse. Here we will highlight evidence of dynamic epigenetic changes in the developing brain in response to variation in the quality of postnatal parent-offspring interactions. The recruitment of epigenetic pathways for the biological embedding of early-life experience may also have transgenerational consequences and we will describe and contrast two routes through which this transmission can occur: experience dependent vs germline inheritance. Finally, we will speculate regarding the future directions of epigenetic research and how it can help us gain a better understanding of the developmental origins of psychiatric dysfunction.

Duration of early adversity and structural brain development in post-institutionalized adolescents

For children reared in institutions for orphaned or abandoned children, multiple aspects of the early environment deviate from species-typical experiences, which may lead to alterations in neurobehavioral development. Although the effects of early deprivation and early life stress have been studied extensively in animal models, less is known about implications for human brain development. This structural neuroimaging study examined the long-term neural correlates of early adverse rearing environments in a large sample of 12-14 year old children (N = 110) who were internationally adopted from institutional care as young children (median age at adoption = 12 months) relative to a same age, comparison group reared with their biological families in the United States. History of institutional rearing was associated with broad changes in cortical volume even after controlling for variability in head size. Results suggested that prefrontal cortex was especially susceptible to early adversity, with significant reductions in volume (driven primarily by differences in surface area rather than cortical thickness) in post-institutionalized youth. Hippocampal volumes showed an association with duration of institutional care, with later-adopted children showing the smallest volumes relative to non-adopted controls. Larger amygdala volumes were not detected in this sample of post-institutionalized children. These data suggest that this temporally discrete period of early deprivation is associated with persisting alterations in brain morphology even years after exposure. Furthermore, these alterations are not completely ameliorated by subsequent environmental enrichment by early adolescence.

Role of sensory, social, and hormonal signals from the mother on the development of offspring

For mammals, sensory, social, and hormonal experience early in life is essential for the continuity of the infant's development. These experiences come from the mother through maternal care, and have enduring effects on the physiology and behavior of the adult organism. Disturbing the mother-offspring interaction by maternal deprivation (neglect) or exposure to adverse events as chronic stress, maltreatment, or sexual abuse has negative effects on the mental, psychological, physiological, and behavioral health. Indeed, these kinds of negative experiences can be the source of some neuropsychiatric diseases as depression, anxiety, impulsive aggression, and antisocial behavior. The purpose of this chapter is to review the most relevant evidence that supports the participation of cues from the mother and/or littermates during the postnatal preweaning period for the development of nervous system of the offspring. These findings come from the most frequently utilized experimental paradigms used in animal models, such as natural variations in maternal behavior, handling, partial maternal deprivation, and total maternal deprivation and artificial rearing. Through the use of these experimental procedures, it is possible to positively (handling paradigm), or negatively (maternal deprivation paradigms), affect the offspring's development. Finally, this chapter reviews the importance of the hormones that pups ingest through the maternal milk during early lactation on the development of several physiological systems, including the immune, endocrine systems, as well as on the adult behavior of the offspring.

Child and adolescent changes to DSM-5

AIM

To describe child and adolescent changes to the DSM-5 and discuss controversial changes.

METHOD

Relevant changes to the structure and categorization of DSM-5 childhood conditions are examined, and controversial issues noted.

RESULTS

Important overlaps between a number of new conditions are described, and questions raised in relation to underlying assumptions about some new categories.

CONCLUSION

Further research is required to determine the validity of new conditions, and the clinical and service effects of structural changes, particularly in respect of overlapping disorders, and categorical vs severity descriptors.

The importance of early experiences for neuro-affective development

This chapter considers the functional utility of the prolonged period of immaturity in human brain development. Development of the amygdala and its connections with the prefrontal cortex is used as an example system for discussing the special role of sensitive periods in shaping neural functional architecture. The argument is made that neural immaturity during childhood may be important and confer a longer period of neuroplasticity, which can increase learning from the environment.

Translation gone awry: differences between commonsense and science

A general assumption is that science is just organised commonsense. It is noted that translation involves a two-way pathway between basic laboratory science and patient care, and that some scientific findings have implications for prevention rather than treatment. A succinct critique follows on the key features that differentiate science and commonsense. The main part of the paper discusses six rather different examples of translation that went awry because people treated science and commonsense as equivalent. Examples based on empirical evidence of translation going awry include (i) the claim that only early intervention can bring lasting benefits; (ii) the claim that the main policy goal for children should be the elimination of all stresses; (iii) the claim that exposure in utero to maternal smoking causes ADHD and conduct disturbance; (iv) the claim that tax benefits should be used to encourage couples to marry; (v) the effects of profound institutional deprivation are similar to those of any adversity; and (vi) environmental effects are largely independent of genetic influences. Much of science is 'unnatural' in the sense that technical tools (such as imaging or DNA) are employed, or because animal models are used, or because unusual comparisons are made. Science cannot be based solely on an inductive process; rather, there must be some form of experiment and the testing of two or more alternative explanations. Translation needs to be based on top quality science and an appreciation that even the best science needs to take account of multiple strategies and multiple evaluations.

Outcomes of traumatic exposure

There is a great need to recognize, prevent, reduce, or treat the immediate and long-term effects of childhood trauma. Most children affected by trauma will not develop long-term posttraumatic sequelae due to their resilience, but comorbid psychopathological outcomes occur and are more common after exposure to severe traumatic events. Factors influencing posttraumatic outcomes are numerous. Young dependent children tend to be more susceptible than older children; children with pain or injury are also more susceptible. Psychopathological effects may not be evident until adulthood. Awareness of the range of adverse outcomes underscores the importance of preventive interventions, accurate assessment, diagnosis and where possible, treatment. Advocacy and public policy initiatives are essential to improving outcomes.

Beyond stimulus deprivation: iron deficiency and cognitive deficits in postinstitutionalized children

Children adopted from institutions have been studied as models of the impact of stimulus deprivation on cognitive development (Nelson, Bos, Gunnar, & Sonuga-Barke, 2011), but these children may also suffer from micronutrient deficiencies (Fuglestad et al., 2008). The contributions of iron deficiency (ID) and duration of deprivation on cognitive functioning in children adopted from institutions between 17 and 36 months of age were examined. ID was assessed in 55 children soon after adoption, and cognitive functioning was evaluated 11-14.6 months postadoption when the children averaged 37.4 months old (SD = 4.9). ID at adoption and longer duration of institutional care independently predicted lower IQ scores and executive function (EF) performance. IQ did not mediate the association between ID and EF.

Reward: commentary. Temporal discounting in conduct disorder: toward an experience-adaptation hypothesis of the role of psychosocial insecurity

Young people with conduct disorder often experience histories of psychosocial adversity and socioeconomic insecurity. For these individuals, real-world future outcomes are not only delayed in their delivery but also highly uncertain. Under such circumstances, accentuated time preference (extreme favoring of the present over the future) is a rational response to the everyday reality of social and economic transactions. Building on this observation, the author sets out the hypothesis that the exaggerated temporal discounting displayed by individuals with conduct disorder reported by White et al. (2014) is an adaptation to chronic exposure to psychosocial insecurity during development. The author postulates that this adaptation leads to (a) a decision-making bias whereby delay and uncertainty are coded as inseparable characteristics of choice outcomes and/or (b) reprogramming of the brain networks regulating intertemporal decision making. Future research could explore the putative role of environmental exposures to adversity in the development of exaggerated temporal discounting in conduct disorder as well as the mediating role of putative cognitive and neurobiological adaptations.

The future is now: early life events preset adult behaviour

To consider the evidence that human and animal behaviours are epigenetically programmed by lifetime experiences. Extensive PubMed searches were carried out to gain a broad view of the topic, in particular from the perspective of human psychopathologies such as mood and anxiety disorders. The selected literature cited is complemented by previously unpublished data from the authors' laboratories. Evidence that physiological and behavioural functions are particularly sensitive to the programming effects of environmental factors such as stress and nutrition during early life, and perhaps at later stages of life, is reviewed and extended. Definition of stimulus- and function-specific critical periods of programmability together with deeper understanding of the molecular basis of epigenetic regulation will deliver greater appreciation of the full potential of the brain's plasticity while providing evidence-based social, psychological and pharmacological interventions to promote lifetime well-being.

Indiscriminate amygdala response to mothers and strangers after early maternal deprivation

BACKGROUND

In altricial species, maternal stimuli have powerful effects on amygdala development and attachment-related behaviors. In humans, maternal deprivation has been associated with both "indiscriminate friendliness" toward non-caregiving adults and altered amygdala development. We hypothesized that maternal deprivation would be associated with reduced amygdala discrimination between mothers and strangers and increased parent report of indiscriminate friendliness behaviors.

METHODS

Sixty-seven youths (33 previously institutionalized; 34 comparison; age-at-scan 4-17 years) participated in a functional magnetic resonance imaging experiment designed to examine amygdala response to mother versus stranger faces. In-scanner behavior was measured. Indiscriminate friendliness was assessed with parental report.

RESULTS

Comparison youth showed an amygdala response that clearly discriminated mother versus stranger stimuli. Previously institutionalized youths, by contrast, exhibited reduced amygdala discrimination between mothers and strangers. Reduced amygdala differentiation correlated with greater reports of indiscriminate friendliness. These effects correlated with age-at-adoption, with later adoptions being associated with reduced amygdala discrimination and more indiscriminate friendliness.

CONCLUSIONS

Our results suggest that early maternal deprivation is associated with reduced amygdala discrimination between mothers and strangers, and reduced amygdala discrimination was associated with greater reports of indiscriminate friendliness. Moreover, these effects increased with age-at-adoption. These data suggest that the amygdala, in part, is associated with indiscriminate friendliness and that there might be a dose-response relationship between institutional rearing and indiscriminate friendliness.

Early-life stress has persistent effects on amygdala function and development in mice and humans

Relatively little is known about neurobiological changes attributable to early-life stressors (e.g., orphanage rearing), even though they have been associated with a heightened risk for later psychopathology. Human neuroimaging and animal studies provide complementary insights into the neural basis of problem behaviors following stress, but too often are limited by dissimilar experimental designs. The current mouse study manipulates the type and timing of a stressor to parallel the early-life stress experience of orphanage rearing, controlling for genetic and environmental confounds inherent in human studies. The results provide evidence of both early and persistent alterations in amygdala circuitry and function following early-life stress. These effects are not reversed when the stressor is removed nor diminished with the development of prefrontal regulation regions. These neural and behavioral findings are similar to our human findings in children adopted from orphanages abroad in that even following removal from the orphanage, the ability to suppress attention toward potentially threatening information in favor of goal-directed behavior was diminished relative to never-institutionalized children. Together, these findings highlight how early-life stress can lead to altered brain circuitry and emotion dysregulation that may increase the risk for psychopathology.

Early developmental emergence of human amygdala-prefrontal connectivity after maternal deprivation

Under typical conditions, medial prefrontal cortex (mPFC) connections with the amygdala are immature during childhood and become adult-like during adolescence. Rodent models show that maternal deprivation accelerates this development, prompting examination of human amygdala-mPFC phenotypes following maternal deprivation. Previously institutionalized youths, who experienced early maternal deprivation, exhibited atypical amygdala-mPFC connectivity. Specifically, unlike the immature connectivity (positive amygdala-mPFC coupling) of comparison children, children with a history of early adversity evidenced mature connectivity (negative amygdala-mPFC coupling) and thus, resembled the adolescent phenotype. This connectivity pattern was mediated by the hormone cortisol, suggesting that stress-induced modifications of the hypothalamic-pituitary-adrenal axis shape amygdala-mPFC circuitry. Despite being age-atypical, negative amygdala-mPFC coupling conferred some degree of reduced anxiety, although anxiety was still significantly higher in the previously institutionalized group. These findings suggest that accelerated amygdala-mPFC development is an ontogenetic adaptation in response to early adversity.

Age at adoption from institutional care as a window into the lasting effects of early experiences

One of the major questions of human development is how early experience impacts the course of development years later. Children adopted from institutional care experience varying levels of deprivation in their early life followed by qualitatively better care in an adoptive home, providing a unique opportunity to study the lasting effects of early deprivation and its timing. The effects of age at adoption from institutional care are discussed for multiple domains of social and behavioral development within the context of several prominent developmental hypotheses about the effects of early deprivation (cumulative effects, experience-expectant developmental programming, and experience-adaptive developmental programming). Age at adoption effects are detected in a majority of studies, particularly when children experienced global deprivation and were assessed in adolescence. For most outcomes, institutionalization beyond a certain age is associated with a step-like increase in risk for lasting social and behavioral problems, with the step occurring at an earlier age for children who experienced more severe levels of deprivation. Findings are discussed in terms of their concordance and discordance with our current hypotheses, and speculative explanations for the findings are offered.

Perinatal problems and psychiatric comorbidity among children with ADHD

Among two large, independent samples of girls with attention-deficit/hyperactivity disorder (ADHD), we examined associations between specific (maternal gestational smoking and drug use, early labor, low birth weight, and infant breathing problems at birth) and cumulative prenatal and perinatal risk factors and psychiatric comorbidity during childhood. Data from the (a) Multimodal Treatment Study of Children with ADHD, a randomized clinical trial with 579 children aged 7 to 9.9 years with combined-type ADHD, and the (b) Berkeley Girls ADHD Longitudinal Sample, a naturalistic study of 140 girls with ADHD (93 combined-type and 47 inattentive-type) who were first seen when they were 6 to 12 years old, were analyzed separately. In each sample, perinatal risk factors were assessed retrospectively by maternal report, and current childhood psychiatric comorbidity was assessed using maternal report on the Diagnostic Interview Schedule for Children. Consistent findings across these two studies show that infant breathing problems, early labor, and total perinatal problems predicted childhood comorbid depression but not comorbid anxiety or externalizing disorders. These associations remained significant, in both samples, with control of family socioeconomic status (SES) and maternal symptoms of ADHD and depression. Results attenuated slightly with control of the number of child comorbidities plus SES and maternal symptoms. Accumulating evidence suggests that perinatal risk factors are important precursors of childhood psychiatric comorbidity and that the association between these risk factors and detrimental psychiatric outcomes cannot be explained by maternal psychiatric symptoms or SES during childhood.

Perinatal problems and psychiatric comorbidity among children with ADHD

Among two large, independent samples of girls with attention-deficit/hyperactivity disorder (ADHD), we examined associations between specific (maternal gestational smoking and drug use, early labor, low birth weight, and infant breathing problems at birth) and cumulative prenatal and perinatal risk factors and psychiatric comorbidity during childhood. Data from the (a) Multimodal Treatment Study of Children with ADHD, a randomized clinical trial with 579 children aged 7 to 9.9 years with combined-type ADHD, and the (b) Berkeley Girls ADHD Longitudinal Sample, a naturalistic study of 140 girls with ADHD (93 combined-type and 47 inattentive-type) who were first seen when they were 6 to 12 years old, were analyzed separately. In each sample, perinatal risk factors were assessed retrospectively by maternal report, and current childhood psychiatric comorbidity was assessed using maternal report on the Diagnostic Interview Schedule for Children. Consistent findings across these two studies show that infant breathing problems, early labor, and total perinatal problems predicted childhood comorbid depression but not comorbid anxiety or externalizing disorders. These associations remained significant, in both samples, with control of family socioeconomic status (SES) and maternal symptoms of ADHD and depression. Results attenuated slightly with control of the number of child comorbidities plus SES and maternal symptoms. Accumulating evidence suggests that perinatal risk factors are important precursors of childhood psychiatric comorbidity and that the association between these risk factors and detrimental psychiatric outcomes cannot be explained by maternal psychiatric symptoms or SES during childhood.

Emotion regulation development of children adopted from institutional care

Számtalan nemzetközi vizsgálat igazolta, hogy az intézetekből örökbefogadott gyerekek, bár sok területen jelentős fejlődést mutatnak, még évekkel családba kerülésük után is sok szocioemocionális problémával küzdenek. Nagyon keveset tudunk azonban azokról a folyamatokról, amelyeken keresztül a korai élmények ezekhez a fejlődési problémákhoz vezetnek. Az itt bemutatott vizsgálat célja az érzelemregulációs képességek fejlődésének jobb megismerése örökbefogadott gyermekeknél, mivel ezen képességek alapvető feltételei a pszichés egészségnek, a hatékony társas működésnek. A vizsgálat központi hipotézise, hogy azok a gyerekek, akik életük első (minimum) 6 hónapját intézetben töltötték, fejletlenebb érzelemregulációs képességgel rendelkeznek. A vizsgálatban 90 4 és 6 év közötti gyerek vett részt, akik a 3 vizsgálati csoport egyikébe tartoztak: 1. olyan gyerekek, akik születésükkor gyermekotthonba kerültek, és ott éltek örökbefogadásukig, de leg¬alább 6 hónapos korukig; 2. csecsemőkorban (6 hetes koruk előtt) örökbefogadott gyerekek; 3. (kontroll) vér szerinti családjukban élő gyerekek. A vizsgálat során az érzelemregulációs képességet a játék-narratívák elemzésével (MacArthur Story Stem Battery) vizsgáltuk. A három vizsgálati csoport összehasonlításának eredményeit összefoglalva elmondható, hogy igazolódott az a hipotézis, miszerint az intézeti gondozás egyik fontos következménye az elmaradás az érzelemregulációs képességekben. Ugyanakkor az eredmények arra is felhívják a figyelmet, hogy az újszülött korban örökbefogadott gyerekek bizonyos érzelemregulációs képességei is, bár jóval kevésbé, de eltérnek a vér szerinti kontrollcsoportétól. Ez az eredmény összefüggésbe hozható egyrészt pre- és perinatális tényezőkkel, másrészt pedig az örökbefogadó szülők és család jellegzetességeivel, valamint az örökbefogadottság tényéből következő vulnerabilitással.

Global perspective on early diagnosis and intervention for children with developmental delays and disabilities

Low- and middle-income countries are experiencing a significant reduction in mortality of children under 5 years of age. This reduction is bringing in its wake large numbers of surviving children with developmental delays and disabilities. Very little attention has been paid to these children, most of whom receive minimal or no support. Thus, there is an urgent need to recognize that improving the quality of life of the survivors must complement mortality reduction in healthcare practice and programs. The incorporation of early evaluation and intervention programs into routine pediatric care is likely to have the most impact on the quality of life of these children. We therefore call for leadership from practitioners, governments, and international organizations to prioritize regular childhood developmental surveillance for possible delays and disabilities, and to pursue early referral for intervention.

Achievements and challenges in the biology of environmental effects

The starting point for the study of adverse experiences is that some have enduring consequences that continue after the period of exposure to the adversity. That raises four basic issues: whether social adversities can be considered homogeneous, whether the crucial effect lies in the "objective" or subjectively perceived "effective" environment, whether the effects are environmentally mediated, and whether the form of biological embedding involves psychological or health consequences. The findings in the literature are discussed in relation to the biological effects of supposedly positive or normal experiences, the use of natural experiments to determine the causal effects of early experience, the heterogeneity of social adversity, the possible mediators of the biological embedding, gene-environment interdependence, and remaining challenges.

Risk and developmental heterogeneity in previously institutionalized children

This article presents an overview of the developmental outcomes of children adopted from institutional care. The author describes how institutional care is a risk factor for typical human development and describes the areas of development, both behavioral and neurobiological, that are most vulnerable to this risk. Also described is variation in outcome and resilience, where some children thrive despite exposure to adverse rearing conditions. The author concludes with an emphasis on heterogeneity in outcome, describing how the risk associated with institutional care is not a deterministic factor but rather an influential one.

Adolescent fertility and risky environments: a population-level perspective across the lifespan

Timing of first reproduction is a key life-history variable with important implications for global economic development and health. Life-history theory predicts that human reproductive strategies are shaped by mortality regimes. This study provides the first test of the relationship between population-level adolescent fertility (AF) and extrinsic risk at two time points. Data are from United Nations database and were analysed using mediation and moderation techniques. The goals were to determine whether (i) early risk has a stronger impact on fertility than current risk; (ii) current risk mediates the relationship between early risk and fertility outcomes; and (iii) different levels of early risk influence the relationship between current risk and fertility. Results indicated that current risk partially mediated the relationship between early risk and fertility, with early risk having the strongest impact on reproduction. Measures for early and current mortality did not show significant interaction effects. However, a series of separate regression analyses using a quantile split of early risk indicated that high levels of early risk strengthened the relationship between current risk and AF. Overall, these findings demonstrate that reproductive strategies are significantly influenced by fluctuations of early mortality as well as current environmental cues of harshness.

Elevated amygdala response to faces following early deprivation

A functional neuroimaging study examined the long-term neural correlates of early adverse rearing conditions in humans as they relate to socio-emotional development. Previously institutionalized (PI) children and a same-aged comparison group were scanned using functional magnetic resonance imaging (fMRI) while performing an Emotional Face Go/Nogo task. PI children showed heightened activity of the amygdala, a region that supports emotional learning and reactivity to emotional stimuli, and corresponding decreases in cortical regions that support perceptual and cognitive functions. Amygdala activity was associated with decreased eye-contact as measured by eye-tracking methods and during a live dyadic interaction. The association between early rearing environment and subsequent eye-contact was mediated by amygdala activity. These data support the hypothesis that early adversity alters human brain development in a way that can persist into childhood, and they offer insight into the socio-emotional disturbances in human behavior following early adversity.

Infants' responsiveness, attachment, and indiscriminate friendliness after international adoption from institutions or foster care in China: application of Emotional Availability Scales to adoptive families

In a short-term longitudinal design we investigated maternal sensitivity, child responsiveness, attachment, and indiscriminate friendliness in families with children internationally adopted from institutions or foster care in China. Ninety-two families with 50 postinstitutionalized and 42 formerly fostered girls, aged 11-16 months on arrival, were studied 2 and 6 months after adoption. Maternal sensitivity and child responsiveness were observed with the Emotional Availability Scales, attachment was assessed with the Strange Situation procedure, and mothers reported on children's indiscriminate friendliness. The postinstitutionalized children showed less secure attachment, whereas the former foster children did not differ from the normative distribution of attachment security. However, at both assessments the two groups of adopted children showed more disorganized attachments compared to normative data. Adoptive mothers of postinstitutionalized and former foster children were equally sensitive and their sensitivity did not change over time. Postinstitutionalized and former foster children did not differ on indiscriminate friendliness, but children with more sensitive adoptive mothers showed less indiscriminate friendliness. The former foster children showed a larger increase in responsiveness over time than the postinstitutionalized children, suggesting that children's responsiveness is more sensitive to change than attachment, and that preadoption foster care is more beneficial for the development of children's responsiveness after adoptive placement than preadoption institutional care.

Continuity and discontinuity of attachment patterns: a short-term longitudinal pilot study using a sample of late-adopted children and their adoptive mothers

This study analysed the attachment patterns of 28 late-adopted children (placed when they were between four and seven years of age) and their adoptive mothers. The change in the children's internal working models (IWMs) within seven to eight months of their placement was evaluated. In addition, we wanted to observe the influence of a secure-autonomous maternal state of mind in facilitating the change in the children's IWMs and the possible associations between the maternal IWMs and the children's IWMs in the adoptive dyads. The separation-reunion procedure (SRP) was used for the late-adopted children in order to assess their attachment behavioural patterns, and the Manchester Child Attachment Story Task (MCAST) was used to evaluate their attachment narrative patterns. The adoptive mothers completed the Adult Attachment Interview (AAI) in order to classify their state of mind with regard to attachment. The results showed a significant change in the attachment behavioural patterns of late-adopted children, from insecure to secure (p = .002). Furthermore, the children who presented this change were predominantly placed with secure-autonomous adoptive mothers (p = .047), although the link between the adoptive mothers' representations of their attachment history and their adopted children's completed narratives was not significant. In conclusion, it seems possible to revise the attachment behaviour of late-adopted children but, for about one-third of children, the adverse history will persist at a narrative/representational level.

Health across early childhood and socioeconomic status: examining the moderating effects of differential parenting

Variations in parenting within the family (i.e. differential parenting) are associated with various domains of child adjustment, whereby disfavoured siblings exhibit poorer social and emotional outcomes. To date there is no research examining the effects of differential parenting on children's general health, or the way in which differential parenting interacts with socioeconomic markers to predict general health over time. The present study assessed 501 Canadian families at 2 time points separated by 18 months. Differential maternal negativity predicted worse health 18 months later. Moreover, the association between maternal education and child health was strongest when children were also exposed to high levels of differential negativity. Findings indicate that multiple forms of social disadvantage (i.e. between families and between siblings) can operate independently or in a cumulative fashion to predict health across early childhood.

Mismatch or cumulative stress: toward an integrated hypothesis of programming effects

This paper integrates the cumulative stress hypothesis with the mismatch hypothesis, taking into account individual differences in sensitivity to programming. According to the cumulative stress hypothesis, individuals are more likely to suffer from disease as adversity accumulates. According to the mismatch hypothesis, individuals are more likely to suffer from disease if a mismatch occurs between the early programming environment and the later adult environment. These seemingly contradicting hypotheses are integrated into a new model proposing that the cumulative stress hypothesis applies to individuals who were not or only to a small extent programmed by their early environment, while the mismatch hypothesis applies to individuals who experienced strong programming effects. Evidence for the main effects of adversity as well as evidence for the interaction between adversity in early and later life is presented from human observational studies and animal models. Next, convincing evidence for individual differences in sensitivity to programming is presented. We extensively discuss how our integrated model can be tested empirically in animal models and human studies, inviting researchers to test this model. Furthermore, this integrated model should tempt clinicians and other intervenors to interpret symptoms as possible adaptations from an evolutionary biology perspective.

The Neurobiological Toll of Early Human Deprivation

Children raised in institutions frequently suffer from a variety of behavioral, emotional, and neuropsychological sequelae, including deficits in attention, executive functions, disorders of attachment and in some cases a syndrome that mimics autism. The extent and severity of these disorders appears to be mediated, in part, by the age at which the child entered and, in some cases, left the institution. Here we review the neurobiological literature on early institutionalization that may account for the psychological and neurological sequelae discussed in other chapters in this volume.

Growth delay as an index of allostatic load in young children: predictions to disinhibited social approach and diurnal cortisol activity

The goal of this study was to examine whether growth delay can serve as an index of allostatic load during early development, as it is well known that the activity of stress-mediating systems inhibits growth. The participants were children adopted internationally from institutional care (n = 36), children adopted internationally from foster care (n = 26), and nonadopted children (n = 35). For the adopted children, height for age and weight for height were assessed at adoption; for all children, disinhibited social approach (DSA; termed elsewhere as "indiscriminate friendliness") and diurnal cortisol were assessed at 6-8 years (M = 6.9 years). For internationally adopted children in general, and postinstitutionalized children specifically, linear growth delay assessed at the time of adoption was associated with more dysregulated behavior in response to an unfamiliar adult (i.e., greater DSA) and a more dysregulated diurnal cortisol rhythm (i.e., higher late afternoon and evening values). Further, among the most growth-delayed children, higher cortisol levels later in the day were correlated with DSA. The potential for using growth delay as an allostatic load indicator and the possible problems and limitations in its use in child populations are discussed.