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Baptista J, Silva JR, Marques S, Martins C, Soares I. EARLY MALTREATMENT AND CURRENT QUALITY OF RELATIONAL CARE PREDICT SOCIOEMOTIONAL PROBLEMS AMONG INSTITUTIONALIZED INFANTS AND TODDLERS. Infant Ment Health J 2018; 39:718-729. [PMID: 30339735 DOI: 10.1002/imhj.21741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The present study is focused on child socioemotional problems 6 months after institutionalization, by considering the putative predictive role of child maltreatment, of developmental functioning at admission and the following months, and of the quality of institutional relational care. Fifty institutionalized infants and toddlers participated in this study. Child developmental functioning (i.e., cognitive, language, and motor development) was assessed at admission to the institution (Wave 0), and 3 (Wave 1) and 6 months (Wave 2) thereafter. The quality of institutional relational care-operationalized in terms of caregivers' sensitivity and cooperation-was measured at Wave 2. Caregivers reported on the presence of disturbed socioemotional behaviors at Wave 2. Child gestational age, birth weight, age, and stunted growth at admission to the institution served as covariates. Results revealed significant associations between socioemotional difficulties and lower levels of motor development at Waves 0 and 1, child maltreatment, and less sensitive caregiving. A logistic regression showed that child maltreatment and caregiver insensitivity were the only significant predictors of disturbed socioemotional functioning by the end of 6 months of institutionalization.
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Affiliation(s)
- Joana Baptista
- University of Minho, School of Psychology, CIPsi, Braga, Portugal.,Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal
| | - Joana R Silva
- University of Minho, School of Psychology, CIPsi, Braga, Portugal
| | - Sofia Marques
- University of Minho, School of Psychology, CIPsi, Braga, Portugal
| | - Carla Martins
- University of Minho, School of Psychology, CIPsi, Braga, Portugal
| | - Isabel Soares
- University of Minho, School of Psychology, CIPsi, Braga, Portugal
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52
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Early Caregiver–Child Interaction and Children’s Development: Lessons from the St. Petersburg-USA Orphanage Intervention Research Project. Clin Child Fam Psychol Rev 2018; 22:208-224. [DOI: 10.1007/s10567-018-0270-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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53
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Weine SM, Langenecker S, Arenliu A. Global mental health and the National Institute of Mental Health Research Domain Criteria. Int J Soc Psychiatry 2018; 64:436-442. [PMID: 29783872 DOI: 10.1177/0020764018778704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) project presents innovative ways of investigating mental illness based on behavioral and neurobiological measures of dimensional processes. Although cultural psychiatrists have critiqued RDoC's implications and limitations for its under-developed focus on context and experience, RDoC presents opportunities for synergies with global mental health. It can capture aspects of clinical or sub-clinical behavior which are less dependent upon Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) and perhaps better elucidate the role of culture in disease expression and resilience. Aim/Results: This article uses the example of migration to describe several starting points for new research: (1) providing components for building an investigable conceptual framework to understand individual's mental health, resilience and adjustment to migration challenges or social adversities in low- and middle-income countries (LMICs) and (2) identifying measurable factors which determine resilience or vulnerability, to guide development and evaluation of targeted prevention, treatment and recovery strategies for mental health in LMICs. CONCLUSION In such ways, RDoC frameworks could help put the new cutting edge neurobiological dimensional scientific advances in a position to contribute to addressing mental health problems amid social adversities in LMICs. However, this would require a much-expanded commitment by both RDoC and global mental health researchers to address contextual and experiential dimensions.
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Affiliation(s)
- Stevan Merill Weine
- 1 Department of Psychiatry, University of Illinois in Chicago, Chicago, IL, USA
| | - Scott Langenecker
- 1 Department of Psychiatry, University of Illinois in Chicago, Chicago, IL, USA
| | - Aliriza Arenliu
- 2 Department of Psychology, Faculty of Philosophy, University of Pristina, Pristina, Republic of Kosovo
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54
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Humphreys KL, Miron D, McLaughlin KA, Sheridan MA, Nelson CA, Fox NA, Zeanah CH. Foster care promotes adaptive functioning in early adolescence among children who experienced severe, early deprivation. J Child Psychol Psychiatry 2018; 59:811-821. [PMID: 29389015 PMCID: PMC6214343 DOI: 10.1111/jcpp.12865] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Experiences in early life lay the foundation for later development and functioning. Severe psychosocial deprivation, as experienced by children in early institutional care, constitutes an adverse experience with long-term negative consequences. The Bucharest Early Intervention Project sought to examine the effects of foster care as an alternative to institutional care for abandoned infants in Romanian institutions. METHODS At a mean age of 22 months, institutionalized children were randomized to foster care or care as usual. At age 12 years, we followed-up with 98 of these children (50 randomized to foster care), as well as assessed 49 never institutionalized comparison children. Adaptive functioning was assessed across seven domains-mental health, physical health, substance use, risk-taking behavior, family relations, peer relations, and academic performance. Children at or above the threshold for adaptive functioning in at least six of seven domains were classified as having overall adaptive functioning in early adolescence. RESULTS Among all children who had experienced severe early deprivation, 40% exhibited adaptive functioning. Children randomized to foster care were significantly more likely to exhibit adaptive functioning at age 12 years than children in the care as usual condition (56% vs. 23%). In support of external validity, children who met the threshold for adaptive functioning at age 12 years had higher IQs and were more physiologically responsive to stress. Among children randomized to foster care, children placed prior to age 20 months were more likely to meet the threshold for adaptive functioning than those placed after this age (79% vs. 46%). CONCLUSIONS This study provides causal evidence that placing children into families following severe deprivation increases the likelihood of adaptive functioning in early adolescence.
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Affiliation(s)
| | | | | | | | - Charles A. Nelson
- Boston Children’s Hospital/Harvard Medical School
- Harvard Graduate School of Education
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55
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Early deprivation disruption of associative learning is a developmental pathway to depression and social problems. Nat Commun 2018; 9:2216. [PMID: 29880851 PMCID: PMC5992195 DOI: 10.1038/s41467-018-04381-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/23/2018] [Indexed: 12/20/2022] Open
Abstract
Exposure to psychosocial deprivation is associated with elevations in numerous forms of impairment throughout the life-course. Disruptions in associative learning may be a key mechanism through which adversity, particularly psychosocial deprivation, increases risk for impairment. Existing data consistent with this claim come entirely from correlational studies. Here, we present the first experimental evidence relating psychosocial deprivation and disruptions in multiple forms of associative learning. Using data from the Bucharest Early Intervention Project, we demonstrate that randomized placement into a family caregiving environment during the infant/toddler period as compared to prolonged institutional care normalizes two forms of associative learning in early adolescence: reward responsivity and implicit motor learning. These forms of associative learning significantly mediate the effect of institutional rearing on depressive symptoms and peer relationships. In sum, we provide evidence for a novel pathway linking early experience to psychopathology and peer relationships through basic associative learning mechanisms. Early childhood deprivation such as institutionalization can greatly affect early development. Here, the authors study children who were raised in institutions but later randomly placed in foster care vs. not, to understand how early-life deprivation affects associative learning in adolescence.
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56
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Turner JD. Childhood adversity from conception onwards: are our tools unnecessarily hindering us? J Behav Med 2018; 41:568-570. [PMID: 29802534 DOI: 10.1007/s10865-018-9939-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/16/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Jonathan D Turner
- Department of Infection and Immunity, Luxembourg Institute of Health, 29 rue Henri Koch, 4354, Esch-sur-Alzette, Luxembourg.
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57
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Guyon-Harris KL, Humphreys KL, Fox NA, Nelson CA, Zeanah CH. Course of Disinhibited Social Engagement Disorder From Early Childhood to Early Adolescence. J Am Acad Child Adolesc Psychiatry 2018; 57:329-335.e2. [PMID: 29706162 PMCID: PMC5944354 DOI: 10.1016/j.jaac.2018.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/18/2018] [Accepted: 03/09/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Disinhibited social engagement disorder (DSED) is poorly understood beyond early childhood. The course of DSED signs in a sample of children who experienced severe, early deprivation from early childhood to early adolescence was examined using variable-centered (linear mixed modeling) and person-centered (growth mixture modeling) approaches. METHOD The study included 124 children with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 69 community comparison children matched by age and sex. DSED signs were assessed at baseline (mean age 22 months), 30, 42, and 54 months of age, and 8 and 12 years of age using a validated caregiver report of disturbed attachment behavior. RESULTS Variable-centered analyses based on intent-to-treat groups indicated that signs of DSED decreased sharply for children randomized to foster care and decreased slightly but remained high for children randomized to care as usual. Person-centered analyses showed 4 profiles (i.e., elevated, persistent modest, early decreasing, and minimal). Elevated and persistent modest courses were associated with greater placement disruptions (F3,99 = 4.29, p = .007, partial eta-squared [η2] = 0.12), older age at placement into foster care (F3,56 = 3.41, p < .05, partial η2 = 0.16), and more time in institutional care (F3,115 = 11.91, p < .001, partial η2 = 0.24) compared with decreasing and minimal courses. CONCLUSION Early and sustained placement into families after deprivation is associated with minimal or decreasing signs of DSED across development. Shortening the amount of time children spend in institutions and preserving placements could help decrease signs of DSED into early adolescence in previously institutionalized children.
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Affiliation(s)
| | - Kathryn L Humphreys
- Tulane University School of Medicine, New Orleans, LA; Stanford University, Stanford, CA
| | | | - Charles A Nelson
- Boston Children's Hospital and Harvard Medical School, Boston, and the Harvard Graduate School of Education, Cambridge, MA
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58
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Deidda M, Boyd KA, Minnis H, Donaldson J, Brown K, Boyer NRS, McIntosh E. Protocol for the economic evaluation of a complex intervention to improve the mental health of maltreated infants and children in foster care in the UK (The BeST? services trial). BMJ Open 2018. [PMID: 29540420 PMCID: PMC5857651 DOI: 10.1136/bmjopen-2017-020066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society in terms of health services, education, social care and judiciary sectors. Evidence suggests that early intervention can mitigate the negative consequences of child maltreatment, exerting long-term positive effects on the health of maltreated children entering foster care. However, evidence on cost-effectiveness of such complex interventions is limited. This protocol describes the first economic evaluation of its kind in the UK. METHODS AND ANALYSIS An economic evaluation alongside the Best Services Trial (BeST?) has been prospectively designed to identify, measure and value key resource and outcome impacts arising from the New Orleans intervention model (NIM) (an infant mental health service) compared with case management (CM) (enhanced social work services as usual). A within-trial economic evaluation and long-term model from a National Health Service/Personal Social Service and a broader societal perspective will be undertaken alongside the National Institute for Health Research (NIHR)-Public Health Research Unit (PHRU)-funded randomised multicentre BeST?. BeST? aims to evaluate NIM compared with CM for maltreated children entering foster care in a UK context. Collection of Paediatric Quality of Life Inventory (PedsQL) and the recent mapping of PedsQL to EuroQol-5-Dimensions (EQ-5D) will facilitate the estimation of quality-adjusted life years specific to the infant population for a cost-utility analysis. Other effectiveness outcomes will be incorporated into a cost-effectiveness analysis (CEA) and cost-consequences analysis (CCA). A long-term economic model and multiple economic evaluation frameworks will provide decision-makers with a comprehensive, multiperspective guide regarding cost-effectiveness of NIM. The long-term population health economic model will be developed to synthesise trial data with routine linked data and key government sector parameters informed by literature. Methods guidance for population health economic evaluation will be adopted (lifetime horizon, 1.5% discount rate for costs and benefits, CCA framework, multisector perspective). ETHICS AND DISSEMINATION Ethics approval was obtained by the West of Scotland Ethics Committee. Results of the main trial and economic evaluation will be submitted for publication in a peer-reviewed journal as well as published in the peer-reviewed NIHR journals library (Public Health Research Programme). TRIAL REGISTRATION NUMBER NCT02653716; Pre-results.
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Affiliation(s)
- Manuela Deidda
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Helen Minnis
- Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Kevin Brown
- Family Assessment and Contact Service, Glasgow, UK
| | - Nicole R S Boyer
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
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59
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Julian MM, McCall RB, Groark CJ, Muhamedrahimov RJ, Palmov OI, Nikiforova NV. Development of children adopted to the United States following a social-emotional intervention in St. Petersburg (Russian Federation) institutions. APPLIED DEVELOPMENTAL SCIENCE 2018; 23:273-293. [PMID: 31488944 PMCID: PMC6727650 DOI: 10.1080/10888691.2017.1420480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study is a post-adoption follow-up of a social-emotional intervention in St. Petersburg, Russian Federation Baby Homes (BHs). Children previously resided in BHs and received Care as Usual (CAU, N=220), Training Only (TO, N=94), or Training plus Structural Changes (T+SC, N=45). This study examined intervention effects 0-6.5 years post-adoption to the USA, at age 9 months to 7 years old. Adoptive parents completed questionnaires on their child's social and behavioral development. Intervention graduates had better attachment security, less indiscriminate friendliness, and fewer behavior problems than CAU graduates. Children who had longer exposure to intervention conditions had better attachment security, but poorer executive function, externalizing and internalizing problems, and competence. Thus, although post-institutionalized children were generally functioning in the normal range in early childhood and effect sizes were small, a social-emotional intervention in institutions is associated with modest benefits to attachment and behavior problems and apparent decrements to executive function.
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60
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Narducci R, Baroncelli L, Sansevero G, Begenisic T, Prontera C, Sale A, Cenni MC, Berardi N, Maffei L. Early impoverished environment delays the maturation of cerebral cortex. Sci Rep 2018; 8:1187. [PMID: 29352131 PMCID: PMC5775315 DOI: 10.1038/s41598-018-19459-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 12/27/2017] [Indexed: 12/26/2022] Open
Abstract
The influence of exposure to impoverished environments on brain development is unexplored since most studies investigated how environmental impoverishment affects adult brain. To shed light on the impact of early impoverishment on developmental trajectories of the nervous system, we developed a protocol of environmental impoverishment in which dams and pups lived from birth in a condition of reduced sensory-motor stimulation. Focusing on visual system, we measured two indexes of functional development, that is visual acuity, assessed by using Visual Evoked Potentials (VEPs), and VEP latency. In addition, we assessed in the visual cortex levels of Insulin-Like Growth Factor 1 (IGF-1) and myelin maturation, together with the expression of the GABA biosynthetic enzyme GAD67. We found that early impoverishment strongly delays visual acuity and VEP latency development. These functional changes were accompanied by a significant reduction of IGF-1 protein and GAD67 expression, as well as by delayed myelination of nerve fibers, in the visual cortex of impoverished pups. Thus, exposure to impoverished living conditions causes a significant alteration of developmental trajectories leading to a prominent delay of brain maturation. These results underscore the significance of adequate levels of environmental stimulation for the maturation of central nervous system.
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Affiliation(s)
- Roberta Narducci
- Institute of Neuroscience, National Research Council (CNR), Via Moruzzi 1, I-56124, Pisa, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, Area San Salvi - Pad. 26, I-50135, Florence, Italy
| | - Laura Baroncelli
- Institute of Neuroscience, National Research Council (CNR), Via Moruzzi 1, I-56124, Pisa, Italy.
| | - Gabriele Sansevero
- Institute of Neuroscience, National Research Council (CNR), Via Moruzzi 1, I-56124, Pisa, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, Area San Salvi - Pad. 26, I-50135, Florence, Italy
| | - Tatjana Begenisic
- Institute of Neuroscience, National Research Council (CNR), Via Moruzzi 1, I-56124, Pisa, Italy
| | - Concetta Prontera
- Fondazione G. Monasterio CNR-Regione Toscana, via Moruzzi 1, I-56124, Pisa, Italy
| | - Alessandro Sale
- Institute of Neuroscience, National Research Council (CNR), Via Moruzzi 1, I-56124, Pisa, Italy
| | - Maria Cristina Cenni
- Institute of Neuroscience, National Research Council (CNR), Via Moruzzi 1, I-56124, Pisa, Italy
| | - Nicoletta Berardi
- Institute of Neuroscience, National Research Council (CNR), Via Moruzzi 1, I-56124, Pisa, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, Area San Salvi - Pad. 26, I-50135, Florence, Italy
| | - Lamberto Maffei
- Institute of Neuroscience, National Research Council (CNR), Via Moruzzi 1, I-56124, Pisa, Italy
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61
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Mohangi K, Pretorius C. On the periphery of HIV and AIDS: Reflections on stress as experienced by caregivers in a child residential care facility in South Africa. SAHARA J 2017; 14:153-161. [PMID: 29065771 PMCID: PMC5678504 DOI: 10.1080/17290376.2017.1389300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Few researchers have investigated how female caregivers of institutionalised children, especially those affected by HIV and AIDS, experience stress. The role played by caregivers cannot be overemphasised; yet caregivers who work in institutions caring for orphaned and/or abandoned children affected by HIV and AIDS, are often marginalised and on the periphery of the HIV and AIDS pandemic. The implication is that insufficient attention or consideration is given to the importance of the role they play in these children's lives. The objective of the study was to explore how female caregivers of institutionalised children affected by HIV and AIDS experience stress. A qualitative research project with a case study design was conducted. The purposively selected participants from a previously identified care facility were seven females in the age ranges of 35-59. Data was gathered during individual interviews and focus group discussions. Thematic content analysis of the data yielded the following themes: (1) contextualising caregiving as 'work'; (2) stresses linked to caregiving; and (3) coping with stress. Findings from this study indicated that participants experienced caregiving in an institution as stressful, demotivating, and emotionally burdensome. Moreover, caregivers working in an environment of HIV and AIDS experienced additional stress related to organisational and management impediments, lack of emotional and practical support, inadequate training, discipline difficulties, and lack of respect and appreciation from the children in their care. It is recommended that training and management support as well as personal support and counselling for caregivers in the institutional context could help them to cope better, feel empowered and to potentially elevate their status as valued members of society.
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Affiliation(s)
- Kesh Mohangi
- PhD, is an associate professor in the Department of Psychology of Education, University of South Africa, Pretoria, South Africa
| | - Chereen Pretorius
- Department of Educational Psychology, University of Pretoria, Pretoria, South Africa
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62
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Social Origins of Developmental Risk for Mental and Physical Illness. J Neurosci 2017; 37:10783-10791. [PMID: 29118206 DOI: 10.1523/jneurosci.1822-17.2017] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 12/19/2022] Open
Abstract
Adversity in early childhood exerts an enduring impact on mental and physical health, academic achievement, lifetime productivity, and the probability of interfacing with the criminal justice system. More science is needed to understand how the brain is affected by early life stress (ELS), which produces excessive activation of stress response systems broadly throughout the child's body (toxic stress). Our research examines the importance of sex, timing and type of stress exposure, and critical periods for intervention in various brain systems across species. Neglect (the absence of sensitive and responsive caregiving) or disrupted interaction with offspring induces robust, lasting consequences in mice, monkeys, and humans. Complementary assessment of internalizing disorders and brain imaging in children suggests that early adversity can interfere with white matter development in key brain regions, which may increase risk for emotional difficulties in the long term. Neural circuits that are most plastic during ELS exposure in monkeys sustain the greatest change in gene expression, offering a mechanism whereby stress timing might lead to markedly different long-term behaviors. Rodent models reveal that disrupted maternal-infant interactions yield metabolic and behavioral outcomes often differing by sex. Moreover, ELS may further accelerate or delay critical periods of development, which reflect GABA circuit maturation, BDNF, and circadian Clock genes. Such factors are associated with several mental disorders and may contribute to a premature closure of plastic windows for intervention following ELS. Together, complementary cross-species studies are elucidating principles of adaptation to adversity in early childhood with molecular, cellular, and whole organism resolution.
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63
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McLaughlin KA, Sheridan MA, Nelson CA. Neglect as a Violation of Species-Expectant Experience: Neurodevelopmental Consequences. Biol Psychiatry 2017; 82:462-471. [PMID: 28392082 PMCID: PMC5572554 DOI: 10.1016/j.biopsych.2017.02.1096] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/03/2017] [Accepted: 02/20/2017] [Indexed: 12/25/2022]
Abstract
The human brain requires a wide variety of experiences and environmental inputs in order to develop normally. Children who are neglected by caregivers or raised in institutional environments are deprived of numerous types of species-expectant environmental experiences. In this review, we articulate a model of how the absence of cognitive stimulation and sensory, motor, linguistic, and social experiences common among children raised in deprived early environments constrains early forms of learning, producing long-term deficits in complex cognitive function and associative learning. Building on evidence from animal models, we propose that deprivation accelerates the neurodevelopmental process of synaptic pruning and limits myelination, resulting in age-specific reductions in cortical thickness and white matter integrity among children raised in deprived early environments. We review evidence linking early experiences of psychosocial deprivation to reductions in cognitive ability, associative and implicit learning, language skills, and executive functions as well as atypical patterns of cortical and white matter development-domains that should be profoundly influenced by deprivation through the learning and neural mechanisms we propose. These patterns of atypical development are difficult to explain with existing models that emphasize stress pathways and accelerated limbic system development. A learning account of how deprived early environments influence cognitive and neural development provides a complementary perspective to stress models and highlights novel pathways through which deprivation might confer risk for internalizing and externalizing psychopathology. We end by reviewing evidence for plasticity in cognitive and neural development among children raised in deprived environments following interventions that improve caregiving quality.
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Affiliation(s)
- Katie A McLaughlin
- Department of Psychology, University of Washington, Seattle, Washington.
| | - Margaret A Sheridan
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles A Nelson
- Division of Developmental Medicine and Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston; Harvard Graduate School of Education, Harvard University, Cambridge, Massachusetts
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Warner HA, McCall RB, Groark CJ, Kim KH, Muhamedrahimov RJ, Palmov OI, Nikiforova NV. CAREGIVER-CHILD INTERACTION, CAREGIVER TRANSITIONS, AND GROUP SIZE AS MEDIATORS BETWEEN INTERVENTION CONDITION AND ATTACHMENT AND PHYSICAL GROWTH OUTCOMES IN INSTITUTIONALIZED CHILDREN. Infant Ment Health J 2017; 38:645-657. [PMID: 28815630 DOI: 10.1002/imhj.21666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This report describes a secondary analysis of data from a comprehensive intervention project which included training and structural changes in three Baby Homes in St. Petersburg, Russian Federation. Multiple mediator models were tested according to the R.M. Baron and D.A. Kenny () causal-steps approach to examine whether caregiver-child interaction quality, number of caregiver transitions, and group size mediated the effects of the intervention on children's attachment behaviors and physical growth. The study utilized a subsample of 163 children from the original Russian Baby Home project, who were between 11 and 19 months at the time of assessment. Results from comparisons of the training and structural changes versus no intervention conditions are presented. Caregiver-child interaction quality and number of caregiver transitions fully mediated the association between intervention condition and attachment behavior. No other mediation was found. Results suggest that the quality of interaction between caregivers and children in institutional care is of primary importance to children's development, but relationship context may play a less direct mediational role, supporting caregiver-child interactions.
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65
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Zeanah CH, Humphreys KL, Fox NA, Nelson CA. Alternatives for abandoned children: insights from the Bucharest Early Intervention Project. Curr Opin Psychol 2017; 15:182-188. [PMID: 28813259 PMCID: PMC5607636 DOI: 10.1016/j.copsyc.2017.02.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/10/2017] [Indexed: 01/23/2023]
Abstract
The Bucharest Early Intervention Project is the first and only randomized controlled trial of foster care as an alternative to institutional care for orphaned and abandoned children. Across various domains of brain and behavioral development we demonstrated that children in families developed more favorably than children in institutions, that foster care remediates some but not all compromises associated with institutional placement and that earlier placement in foster care leads to more developmental gains in some but not all domains. In addition to early placement, higher quality of care provided and more stable placements for children all enhanced outcomes. These results have important implications for science, practice and policy.
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Affiliation(s)
| | | | | | - Charles A Nelson
- Boston Children's Hospital and Harvard Medical School, USA; Harvard Graduate School of Education, USA
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66
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Humphreys KL, Nelson CA, Fox NA, Zeanah CH. Signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years: Effects of institutional care history and high-quality foster care. Dev Psychopathol 2017; 29:675-684. [PMID: 28401844 PMCID: PMC5777580 DOI: 10.1017/s0954579417000256] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Two disorders of attachment have been consistently identified in some young children following severe deprivation in early life: reactive attachment disorder and disinhibited social engagement disorder. However, less is known about whether signs of these disorders persist into adolescence. We examined signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years in 111 children who were abandoned at or shortly after birth and subsequently randomized to care as usual or to high-quality foster care, as well as in 50 comparison children who were never institutionalized. Consistent with expectations, those who experienced institutional care in early life had more signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years than children never institutionalized. In addition, using a conservative intent-to-treat approach, those children randomized to foster care had significantly fewer signs of reactive attachment disorder and disinhibited social engagement disorder than those randomized to care as usual. Analyses within the ever institutionalized group revealed no effects of the age of placement into foster care, but number of caregiving disruptions experienced and the percentage of the child's life spent in institutional care were significant predictors of signs of attachment disorders assessed in early adolescence. These findings indicate that adverse caregiving environments in early life have enduring effects on signs of attachment disorders, and provide further evidence that high-quality caregiving interventions are associated with reductions in both reactive attachment disorder and disinhibited social engagement disorder.
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Affiliation(s)
| | - Charles A. Nelson
- Harvard Medical School and Boston Children’s Hospital, Boston, MA
- Harvard Graduate School of Education, Cambridge, MA
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Baptista J, Belsky J, Mesquita A, Soares I. Serotonin transporter polymorphism moderates the effects of caregiver intrusiveness on ADHD symptoms among institutionalized preschoolers. Eur Child Adolesc Psychiatry 2017; 26:303-313. [PMID: 27430630 DOI: 10.1007/s00787-016-0890-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 07/09/2016] [Indexed: 10/21/2022]
Abstract
Research consistently chronicles a variety of mental health difficulties that plague institutionally reared children, including attention-deficit/hyperactivity disorder (ADHD), even if not all institutionalized children evince such problems. In seeking to extend work in this area, this research on gene × environment (GXE) interplay investigated whether the effect of the quality of institutional care-most notably, caregiver intrusiveness-on ADHD symptoms is moderated by the serotonin transporter (5-HTTLPR) polymorphism. One hundred and twenty-seven institutionalized preschoolers were evaluated using the Child Behavior Checklist. Caregiver-rated attention problems and hyperactivity were unrelated to both 5-HTTLPR polymorphism and caregiver intrusiveness. A significant GXE effect, independent of age at placement or duration of institutionalization, emerged, however, consistent with the differential-susceptibility hypothesis: s/s homozygotes manifest the most and least ADHD symptoms when they experienced, respectively, more and less intrusive caregiving. These results provide new insight into the reasons why some institutionalized children, but not others, exhibit ADHD symptoms.
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Affiliation(s)
- Joana Baptista
- Psychology Research Center-CIPsi, School of Psychology, University of Minho, Campus de Gualtar, 4710-050, Braga, Portugal
| | - Jay Belsky
- University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - Ana Mesquita
- Psychology Research Center-CIPsi, School of Psychology, University of Minho, Campus de Gualtar, 4710-050, Braga, Portugal
| | - Isabel Soares
- Psychology Research Center-CIPsi, School of Psychology, University of Minho, Campus de Gualtar, 4710-050, Braga, Portugal.
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68
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Çatay Z, Koloğlugil D. IMPACT OF A SUPPORT GROUP FOR THE CAREGIVERS AT AN ORPHANAGE IN TURKEY. Infant Ment Health J 2017; 38:289-305. [PMID: 28236315 DOI: 10.1002/imhj.21629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study examined the effectiveness of a 20-session training and supervision support group for caregivers working at an orphanage in Istanbul. The support group's goals were to promote sensitive and responsive caregiving in an institutional setting, to decrease the stress level of the caregivers, and to increase the quality of the relationship between caregivers and children. Thirty-six children (15-37 months) and 24 caregivers participated in this study. Comparison of the pre- and posttest measures of the caregiver intervention and control groups indicated that the intervention yielded successful outcomes. Caregivers in the intervention group displayed significant decreases in the amount of psychological symptoms that they reported and in their emotional burnout levels. Their sense of self-efficacy also improved. In addition, at the end of the 5-month training program, positive developments were observed regarding children's development and problem behaviors. Having regular visitors also was found to be a significant predictor for better developmental outcomes for the children under institutional care.
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69
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D'Agata AL, Sanders MR, Grasso DJ, Young EE, Cong X, Mcgrath JM. UNPACKING THE BURDEN OF CARE FOR INFANTS IN THE NICU. Infant Ment Health J 2017; 38:306-317. [PMID: 28236329 DOI: 10.1002/imhj.21636] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Infants who begin early life in the medicalized environment of the neonatal intensive care unit (NICU) experience disruption to numerous fundamental expectancies. In the NICU, infants are exposed to chronic, extreme stressors that include painful medical procedures and parental separation. Due to their preverbal stage of development, infants are unable to fully express these experiences, and linking these experiences to long-term outcomes has been difficult. This clinical article proposes the terminology Infant Medical Trauma in the NICU (IMTN) to describe the infant experience. Following a discussion of the NICU as an adverse childhood event, the article has three sections: (a) the unique and critical factors that define the newborn period, (b) a review of the IMTN conceptual model, and (c) recommendations for supportive neuroprotective strategies to moderate the intensity of adverse NICU infant experiences.
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Affiliation(s)
- Amy L D'Agata
- University of Connecticut, Storrs, and University of South Florida
| | - Marilyn R Sanders
- Connecticut Children's Medical Center, Hartford and University of Connecticut, Farmington
| | | | - Erin E Young
- University of Connecticut, Storrs, and University of Connecticut, Farmington
| | | | - Jacqueline M Mcgrath
- University of Connecticut, Storrs, and Connecticut Children's Medical Center, Hartford
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Levey EJ, Oppenheim CE, Lange BCL, Plasky NS, Harris BL, Lekpeh GG, Kekulah I, Henderson DC, Borba CPC. A qualitative analysis of parental loss and family separation among youth in post-conflict Liberia. VULNERABLE CHILDREN AND YOUTH STUDIES 2017; 12:1-16. [PMID: 28163770 PMCID: PMC5214285 DOI: 10.1080/17450128.2016.1262978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/09/2016] [Indexed: 06/06/2023]
Abstract
Between 1989 and 2003, the Republic of Liberia experienced a brutal civil war. In 2008, the population was approximately 3.5 million people, and there were an estimated 340,000 orphans. Nearly 6000 more children were orphaned by the Ebola epidemic from 2014-2015. The goal of this research was to explore the impact of parental loss, identify moderating factors, and consider interventions that could help vulnerable youth in post-conflict societies following the loss of a parent. Seventy-five young people (age 13-18 years) in Monrovia, the capital city of Liberia, were recruited in 2012. Semi-structured interviews were conducted, and demographic data were collected. Interviews were then transcribed and coded thematically. The loss of a parent or other primary caregiver had a significant impact on psychosocial and emotional health. The timing of the loss, strength of connection with the deceased parent, and relationship with surviving parent or substitute caregiver were all relevant factors. Children separated from living parents were functioning better than those whose parents were deceased. The case of Liberian children underscores the importance of early caregiver relationships and the difficulties children face when such relationships are disrupted. Children who did not experience stable early relationships suffered disconnection from their families and communities.
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Affiliation(s)
- Elizabeth J. Levey
- Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | | | | | - Naomi S. Plasky
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Benjamin L. Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - G. Gondah Lekpeh
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Isaac Kekulah
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - David C. Henderson
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Christina P. C. Borba
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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71
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Lawler JM, Koss KJ, Doyle CM, Gunnar MR. The course of early disinhibited social engagement among post-institutionalized adopted children. J Child Psychol Psychiatry 2016; 57:1126-34. [PMID: 27460336 PMCID: PMC5030154 DOI: 10.1111/jcpp.12606] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Approximately 20% of post-institutionalized (PI) children exhibit disinhibited social engagement (DSE) or the propensity to approach and engage strangers. There is little longitudinal research examining changes in DSE after adoption, or methods of identifying children with persistent behaviors. METHODS DSE was assessed observationally four times during the first 2 years postadoption in PI children 16-36 months at adoption (n = 68) relative to same-age nonadopted children (n = 52). At age 5, a validated interview determined which PI children met criteria for Disinhibited Social Engagement Disorder (DSED). RESULTS DSE trajectories initially increased and then stabilized. PIs had higher DSE levels initially and a steeper increase rate than NAs. When separated into physical and nonphysical DSE components, group differences arose in initial physical DSE and the rate of change of nonphysical DSE. DSE rate of increase predicted DSED diagnosis, as did longer institutional duration and poorer institutional care. CONCLUSIONS The rate of increase in DSE postadoption, rather than the level observed at adoption, is predictive of disordered social engagement by age 5 years.
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Affiliation(s)
- Jamie M Lawler
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Kalsea J Koss
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Colleen M Doyle
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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Infant Medical Trauma in the Neonatal Intensive Care Unit (IMTN): A Proposed Concept for Science and Practice. Adv Neonatal Care 2016; 16:289-97. [PMID: 27391564 DOI: 10.1097/anc.0000000000000309] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma is an innately subjective experience ensuing from a deeply distressing event. Research has demonstrated that while the environment of the neonatal intensive care unit (NICU) is capable of providing extraordinary lifesaving measures following birth, the experience may be disruptive to several key aspects of early development, placing infants at risk for adverse behavioral, cognitive, and emotional outcomes. PURPOSE This article provides rationale for the concept of Infant Medical Trauma in the NICU (IMTN) as a means of describing this unique stress experience. A triad of cumulative early life NICU experiences (stress, parental separation, and pain) is proposed to influence an infant's swinging neurodevelopmental pendulum amid the potential outcomes of risk and resilience. IMPLICATIONS FOR PRACTICE AND RESEARCH Creating language that describes the infant experience brings meaning and calls caregivers and parents to action to consider strategies that may improve long-term health. Actively seeking opportunities to decrease the allostatic load of at-risk infants may support an infant's pendulum to swing toward a path of resilience, thereby moderating his or her early life adverse experience.
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73
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Differential associations of threat and deprivation with emotion regulation and cognitive control in adolescence. Dev Psychopathol 2016; 29:929-940. [PMID: 27424571 DOI: 10.1017/s0954579416000584] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Research on childhood adversity has traditionally focused on single types of adversity, which is limited because of high co-occurrence, or on the total number of adverse experiences, which assumes that diverse experiences influence development similarly. Identifying dimensions of environmental experience that are common to multiple types of adversity may be a more effective strategy. We examined the unique associations of two such dimensions (threat and cognitive deprivation) with automatic emotion regulation and cognitive control using a multivariate approach that simultaneously examined both dimensions of adversity. Data were drawn from a community sample of adolescents (N = 287) with variability in exposure to violence, an indicator of threat, and poverty, which is associated with cognitive deprivation. Adolescents completed tasks measuring automatic emotion regulation and cognitive control in neutral and emotional contexts. Violence was associated with automatic emotion regulation deficits, but not cognitive control; poverty was associated with poor cognitive control, but not automatic emotion regulation. Both violence and poverty predicted poor inhibition in an emotional context. Utilizing an approach focused on either single types of adversity or cumulative risk obscured specificity in the associations of violence and poverty with emotional and cognitive outcomes. These findings suggest that different dimensions of childhood adversity have distinct influences on development and highlight the utility of a differentiated multivariate approach.
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Serotonin transporter linked polymorphic region (5-HTTLPR) genotype moderates the longitudinal impact of early caregiving on externalizing behavior. Dev Psychopathol 2016; 27:7-18. [PMID: 25640827 DOI: 10.1017/s0954579414001266] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We examined caregiver report of externalizing behavior from 12 to 54 months of age in 102 children randomized to care as usual in institutions or to newly created high-quality foster care. At baseline no differences by group or genotype in externalizing were found. However, changes in externalizing from baseline to 42 months of age were moderated by the serotonin transporter linked polymorphic region genotype and intervention group, where the slope for short-short (S/S) individuals differed as a function of intervention group. The slope for individuals carrying the long allele did not significantly differ between groups. At 54 months of age, S/S children in the foster care group had the lowest levels of externalizing behavior, while children with the S/S genotype in the care as usual group demonstrated the highest rates of externalizing behavior. No intervention group differences were found in externalizing behavior among children who carried the long allele. These findings, within a randomized controlled trial of foster care compared to continued care as usual, indicate that the serotonin transporter linked polymorphic region genotype moderates the relation between early caregiving environments to predict externalizing behavior in children exposed to early institutional care in a manner most consistent with differential susceptibility.
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Predictors of developmental status in young children living in institutional care in Kazakhstan. Matern Child Health J 2016; 19:1408-16. [PMID: 25480471 DOI: 10.1007/s10995-014-1647-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The main objective of this study was to assess the developmental status of children living in the severely adverse environment of institutional care and the examination of risk factors with regard to developmental status, including degree of stunting and emotional-behavioral and anemia status. The Bayley Scales of Infant Development were used to assess development status in 103 children aged 14.9 months (SD = 6.8) in six Kazakh institutions. The Behavioral Rating Scales were used to assess emotional-behavioral regulation. Physical growth measures were converted to z scores using World Health Organization growth charts. Venous blood was collected for assessment of anemia. Our findings indicated that young children in institutions were developmentally compromised, with duration of institutional care correlated with the severity of delay. Negative predictors of developmental status included: Poor emotional-behavioral regulation, degree of stunting and age at assessment. A particularly large percentage of children were found to be anemic. Additionally, low birth weight was found to be a significant negative predictor of development. Our findings indicate that institutional care has a detrimental impact on the development and emotional regulation of young children. Time in institutional care is a negative predictor for cognitive status for children placed at birth. Moreover stunting was found to be a useful indicator of the degree of impact of early adversity on cognitive development. Particular attention is needed for special-needs children such as those with low birth weight, since their development was found to be more sensitive to early adversity than that of normal birth weight children.
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McLaughlin KA. Future Directions in Childhood Adversity and Youth Psychopathology. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 45:361-82. [PMID: 26849071 DOI: 10.1080/15374416.2015.1110823] [Citation(s) in RCA: 300] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite long-standing interest in the influence of adverse early experiences on mental health, systematic scientific inquiry into childhood adversity and developmental outcomes has emerged only recently. Existing research has amply demonstrated that exposure to childhood adversity is associated with elevated risk for multiple forms of youth psychopathology. In contrast, knowledge of developmental mechanisms linking childhood adversity to the onset of psychopathology-and whether those mechanisms are general or specific to particular kinds of adversity-remains cursory. Greater understanding of these pathways and identification of protective factors that buffer children from developmental disruptions following exposure to adversity is essential to guide the development of interventions to prevent the onset of psychopathology following adverse childhood experiences. This article provides recommendations for future research in this area. In particular, use of a consistent definition of childhood adversity, integration of studies of typical development with those focused on childhood adversity, and identification of distinct dimensions of environmental experience that differentially influence development are required to uncover mechanisms that explain how childhood adversity is associated with numerous psychopathology outcomes (i.e., multifinality) and identify moderators that shape divergent trajectories following adverse childhood experiences. A transdiagnostic model that highlights disruptions in emotional processing and poor executive functioning as key mechanisms linking childhood adversity with multiple forms of psychopathology is presented as a starting point in this endeavour. Distinguishing between general and specific mechanisms linking childhood adversity with psychopathology is needed to generate empirically informed interventions to prevent the long-term consequences of adverse early environments on children's development.
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Vanderwert RE, Zeanah CH, Fox NA, Nelson CA. Normalization of EEG activity among previously institutionalized children placed into foster care: A 12-year follow-up of the Bucharest Early Intervention Project. Dev Cogn Neurosci 2016; 17:68-75. [PMID: 26724564 PMCID: PMC4727988 DOI: 10.1016/j.dcn.2015.12.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/01/2015] [Accepted: 12/09/2015] [Indexed: 01/07/2023] Open
Abstract
Extreme social and cognitive deprivation as a result of institutional care has profound effects on developmental outcomes across multiple domains for many abandoned or orphaned children. The Bucharest Early Intervention Project (BEIP) examines the outcomes for children originally placed in institutions who were assessed comprehensively and then randomized to foster care (FCG) or care as usual (CAUG) and followed longitudinally. Here we report on the brain electrical activity (electroencephalogram: EEG) of 12-year-old children enrolled in the BEIP. Previous reports suggested improvement in resting EEG activity for the group of children placed in the foster care intervention, particularly those placed before 24 months of age compared to children who were randomized to CAUG or those placed into families after this age. At 12 years, differences between those in the FCG and those in the CAUG persist in the alpha band (8-13 Hz), but not in higher frequency bands (i.e. in the beta band; 15-30 Hz), except in those children placed into the FCG who remained in high quality care environments over the course of the study. These findings highlight the importance of maintaining a stable high quality caregiving environment, particularly for children exposed to early psychosocial deprivation, for promoting healthy brain development.
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Affiliation(s)
- Ross E Vanderwert
- School of Psychology, Cardiff University, 70 Park Place, Tower Building, Cardiff CF10 3AT, United Kingdom.
| | | | - Nathan A Fox
- University of Maryland, College Park, MD, United States
| | - Charles A Nelson
- Boston Children's Hospital and Harvard Medical School, Boston, MA, United States; Harvard Graduate School of Education, Cambridge, MA, United States; Harvard Center on the Developing Child, Cambridge, MA, United States
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78
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Emotion understanding, parent mental state language, and behavior problems in internationally adopted children. Dev Psychopathol 2015; 28:371-83. [DOI: 10.1017/s095457941500111x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractInternationally adopted postinstitutionalized (PI) children are at risk for lower levels of emotion understanding. This study examined how postadoption parenting influences emotion understanding and whether lower levels of emotion understanding are associated with behavior problems. Emotion understanding and parent mental state language were assessed in 3-year-old internationally adopted PI children (N = 25), and comparison groups of children internationally adopted from foster care (N = 25) and nonadopted (NA) children (N = 36). At 5.5-year follow-up, PI children had lower levels of emotion understanding than NA children, a group difference not explained by language. In the total sample, parent mental state language at age 3 years predicted 5.5-year emotion understanding after controlling for child language ability. The association of parent mental state language and 5.5-year emotion understanding was moderated by adoption status, such that parent mental state language predicted 5.5-year emotion understanding for the internationally adopted children, but not for the NA children. While postadoption experience does not erase negative effects of early deprivation on emotion understanding, results suggest that parents can promote emotion understanding development through mental state talk. At 5.5 years, PI children had more internalizing and externalizing problems than NA children, and these behavioral problems related to lower levels of emotion understanding.
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79
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Kroupina MG, Eckerle JK, Fuglestad AJ, Toemen L, Moberg S, Himes JH, Miller BS, Petryk A, Johnson DE. Associations between physical growth and general cognitive functioning in international adoptees from Eastern Europe at 30 months post-arrival. J Neurodev Disord 2015; 7:36. [PMID: 26568773 PMCID: PMC4644626 DOI: 10.1186/s11689-015-9132-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/27/2015] [Indexed: 12/04/2022] Open
Abstract
Background Internationally adopted children have often experienced early adversity and growth suppression as a consequence of institutional care. Furthermore, these children are at risk for impaired cognitive development due to their early adverse experiences. This study examined the association between physical growth, the growth hormone (GH) system, and general cognitive functioning post-adoption. Based on previous research, we expected to find that a child’s initial physical growth status and normalization of the growth hormone-insulin-like growth factor 1 (GH-IGF-1) axis would be positive predictors of general cognitive functioning. Methods Post-institutionalized children (n = 46) adopted from Eastern Europe were seen approximately 1 month after their arrival into the USA to determine baseline measurements. They were seen again 6 and 30 months later for two follow-up sessions. Measures included anthropometry, insulin-like growth factor-1 (IGF-1), IGF binding protein-3 (IGFBP-3), Mullen Scales of Early Learning, and Stanford-Binet Intelligence Scales. Information about parental education was also collected. Results We found that a child’s general cognitive functioning at 30 months post-adoption was predicted by their general developmental scores at 6 months post-adoption, their initial height status, and markers of the growth hormone system. Children with lower initial IGFBP-3 standard deviation (SD) scores had higher verbal IQ scores at 30 months. Furthermore, a child’s initial height was found to be a significant positive predictor of non-verbal IQ. Conclusions These results suggest an association between a child’s suppressed physical growth in response to early adversity and alterations in GH system functioning and subsequent recovery in cognitive functioning.
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Affiliation(s)
- Maria G Kroupina
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454 USA ; Center for Neurobehavioral Development, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454 USA ; Present address: University of Minnesota, 717 Delaware Street SE, Room 361, Minneapolis, MN 55414 USA
| | - Judith K Eckerle
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454 USA ; Center for Neurobehavioral Development, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454 USA
| | - Anita J Fuglestad
- Department of Psychology, University of North Florida, Jacksonville, FL 32224 USA
| | - Liza Toemen
- Maastricht University, Maastricht, The Netherlands
| | - Stephanie Moberg
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454 USA
| | - John H Himes
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454 USA
| | - Bradley S Miller
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454 USA ; Center for Neurobehavioral Development, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454 USA
| | - Anna Petryk
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454 USA
| | - Dana E Johnson
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454 USA ; Center for Neurobehavioral Development, University of Minnesota Masonic Children's Hospital, Minneapolis, MN 55454 USA
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Hearst MO, Himes JH, Johnson DE, Kroupina M, Syzdykova A, Aidjanov M, Sharmonov T. Growth, nutritional, and developmental status of young children living in orphanages in Kazakhstan. Infant Ment Health J 2015; 35:94-101. [PMID: 25798515 DOI: 10.1002/imhj.21430] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article describes the nutritional and developmental status of young children living in Baby Houses (orphanages for children ages 0-3 years) in Kazakhstan. In 2009/2010, 308 children under age 3 years living in 10 Baby Houses were measured for height/length and weight. The Bayley Scales of Infant Development (N. Bayley, 2006) were used to assess mental and motor development. Blood was collected on a subsample to assess key nutritional factors. The World Health Organization growth charts were used to calculate Z-scores. Cut points for wasting (moderate to severe low weight for length/height growth), underweight (low weight for age), stunting (low length/height for age), development, and biomarkers used established guidelines. Most (n = 286) children had complete data on z-scores. Of these, 22.1% were experiencing wasting, 31.5% were underweight, and 36.7% had stunting. The nutritional status of the children, based on blood biomarkers, revealed that 37.1% of the children were anemic, 21.4% had low albumin, 38.1% had low vitamin D, 5.5% were iodine-deficient, and 2% had low serum zinc. One half had mild to significant mental and motor delays. Children living at these Baby Houses in Kazakhstan have substantial nutritional deficits and developmental delays. Focused attention is needed to provide a nutritionally enhanced diet and improved developmental opportunities to improve the long-term outcomes for these children.
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81
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Ardizzi M, Martini F, Umiltà MA, Evangelista V, Ravera R, Gallese V. Impact of Childhood Maltreatment on the Recognition of Facial Expressions of Emotions. PLoS One 2015; 10:e0141732. [PMID: 26509890 PMCID: PMC4624998 DOI: 10.1371/journal.pone.0141732] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/11/2015] [Indexed: 11/30/2022] Open
Abstract
The development of the explicit recognition of facial expressions of emotions can be affected by childhood maltreatment experiences. A previous study demonstrated the existence of an explicit recognition bias for angry facial expressions among a population of adolescent Sierra Leonean street-boys exposed to high levels of maltreatment. In the present study, the recognition bias for angry facial expressions was investigated in a younger population of street-children and age-matched controls. Participants performed a forced-choice facial expressions recognition task. Recognition bias was measured as participants’ tendency to over-attribute anger label to other negative facial expressions. Participants’ heart rate was assessed and related to their behavioral performance, as index of their stress-related physiological responses. Results demonstrated the presence of a recognition bias for angry facial expressions among street-children, also pinpointing a similar, although significantly less pronounced, tendency among controls. Participants’ performance was controlled for age, cognitive and educational levels and for naming skills. None of these variables influenced the recognition bias for angry facial expressions. Differently, a significant effect of heart rate on participants’ tendency to use anger label was evidenced. Taken together, these results suggest that childhood exposure to maltreatment experiences amplifies children’s “pre-existing bias” for anger labeling in forced-choice emotion recognition task. Moreover, they strengthen the thesis according to which the recognition bias for angry facial expressions is a manifestation of a functional adaptive mechanism that tunes victim’s perceptive and attentive focus on salient environmental social stimuli.
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Affiliation(s)
- Martina Ardizzi
- Department of Neuroscience, University of Parma, Parma, Italy
- Ravera Children Rehabilitation Centre (RCRC), Lakka, Freetown, Sierra Leone
- * E-mail:
| | - Francesca Martini
- Department of Health Psychology, Hospital of Sanremo, Sanremo, Italy
| | | | | | - Roberto Ravera
- Ravera Children Rehabilitation Centre (RCRC), Lakka, Freetown, Sierra Leone
- Department of Health Psychology, Hospital of Sanremo, Sanremo, Italy
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82
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Esposito EA, Koss KJ, Donzella B, Gunnar MR. Early deprivation and autonomic nervous system functioning in post-institutionalized children. Dev Psychobiol 2015; 58:328-40. [PMID: 26497289 DOI: 10.1002/dev.21373] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 10/07/2015] [Indexed: 01/19/2023]
Abstract
The relations between early deprivation and the development of the neuroendocrine and central components of the mammalian stress response have been examined frequently. However, little is known about the impact of early deprivation on the developmental trajectories of autonomic function. Children adopted between 15-36 months from institutional care were examined during their first 16 months post-adoption (N = 60). Comparison groups included same-aged peers reared in their birth families (N = 50) and children adopted internationally from overseas foster care (N = 46). The present study examined trajectories of baseline autonomic nervous system function longitudinally following entry into adopted families. Post-institutionalized children had higher sympathetic tone, measured by pre-ejection period (PEP). Individual differences in PEP soon after adoption served as a mediator between early deprivation and parent-reported behavioral problems 2 years post-adoption. There were no group differences in parasympathetic function, indexed by respiratory sinus arrhythmia. All three groups showed similar trajectories of ANS function across the 16 month period.
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Affiliation(s)
- Elisa A Esposito
- Institute of Child Development, University of Minnesota, Minneapolis, MN, 55455
| | - Kalsea J Koss
- Institute of Child Development, University of Minnesota, Minneapolis, MN, 55455
| | - Bonny Donzella
- Institute of Child Development, University of Minnesota, Minneapolis, MN, 55455
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, Minneapolis, MN, 55455.
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83
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Early deprivation, atypical brain development, and internalizing symptoms in late childhood. Neuroscience 2015; 342:140-153. [PMID: 26384960 DOI: 10.1016/j.neuroscience.2015.09.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/03/2015] [Accepted: 09/09/2015] [Indexed: 11/21/2022]
Abstract
Children exposed to extreme early-life neglect such as in institutional rearing are at heightened risk for developing depression and anxiety disorders, and internalizing problems more broadly. These outcomes are believed to be due to alterations in the development of neural circuitry that supports emotion regulation. The specific neurodevelopmental changes that contribute to these difficulties are largely unknown. This study examined whether microstructural alterations in white matter pathways predicted long-term risk for internalizing problems in institutionally reared children. Data from 69 children were drawn from the Bucharest Early Intervention Project, a randomized clinical trial of foster care for institutionally reared children. White matter was assessed using diffusion tensor imaging (DTI) when children were between 8 and 10years of age. Internalizing symptoms were assessed at the time of the MRI scan, and once children reached 12-14years of age. Results indicated that neglect-associated alterations in the external capsule and corpus callosum partially explained links between institutional rearing status and internalizing symptoms in middle childhood and early adolescence. Findings shed light on neural mechanisms contributing to increased risk for emotional difficulties among children reared in adverse conditions and have implications for prevention and intervention.
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84
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McLaughlin KA, Sheridan MA, Lambert HK. Childhood adversity and neural development: deprivation and threat as distinct dimensions of early experience. Neurosci Biobehav Rev 2015; 47:578-91. [PMID: 25454359 DOI: 10.1016/j.neubiorev.2014.10.012] [Citation(s) in RCA: 650] [Impact Index Per Article: 72.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 09/30/2014] [Accepted: 10/15/2014] [Indexed: 12/16/2022]
Abstract
A growing body of research has examined the impact of childhood adversity on neural structure and function. Advances in our understanding of the neurodevelopmental consequences of adverse early environments require the identification of dimensions of environmental experience that influence neural development differently and mechanisms other than the frequently-invoked stress pathways. We propose a novel conceptual framework that differentiates between deprivation (absence of expected environmental inputs and complexity) and threat (presence of experiences that represent a threat to one's physical integrity) and make predictions grounded in basic neuroscience principles about their distinct effects on neural development. We review animal research on fear learning and sensory deprivation as well as human research on childhood adversity and neural development to support these predictions. We argue that these previously undifferentiated dimensions of experience exert strong and distinct influences on neural development that cannot be fully explained by prevailing models focusing only on stress pathways. Our aim is not to exhaustively review existing evidence on childhood adversity and neural development, but to provide a novel framework to guide future research.
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85
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Berens AE, Nelson CA. The science of early adversity: is there a role for large institutions in the care of vulnerable children? Lancet 2015; 386:388-98. [PMID: 25638660 PMCID: PMC9594997 DOI: 10.1016/s0140-6736(14)61131-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It has been more than 80 years since researchers in child psychiatry first documented developmental delays among children separated from family environments and placed in orphanages or other institutions. Informed by such findings, global conventions, including the 1989 UN Convention on the Rights of the Child, assert a child's right to care within a family-like environment that offers individualised support. Nevertheless, an estimated 8 million children are presently growing up in congregate care institutions. Common reasons for institutionalisation include orphaning, abandonment due to poverty, abuse in families of origin, disability, and mental illness. Although the practice remains widespread, a robust body of scientific work suggests that institutionalisation in early childhood can incur developmental damage across diverse domains. Specific deficits have been documented in areas including physical growth, cognitive function, neurodevelopment, and social-psychological health. Effects seem most pronounced when children have least access to individualised caregiving, and when deprivation coincides with early developmental sensitive periods. Offering hope, early interventions that place institutionalised children into families have afforded substantial recovery. The strength of scientific evidence imparts urgency to efforts to achieve deinstitutionalisation in global child protection sectors, and to intervene early for individual children experiencing deprivation.
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Affiliation(s)
- Anne E Berens
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Charles A Nelson
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA; Harvard Center on the Developing Child, Harvard Graduate School of Education, Cambridge, MA, USA.
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86
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Humphreys KL, Gleason MM, Drury SS, Miron D, Nelson CA, Fox NA, Zeanah CH. Effects of institutional rearing and foster care on psychopathology at age 12 years in Romania: follow-up of an open, randomised controlled trial. Lancet Psychiatry 2015; 2:625-34. [PMID: 26303560 PMCID: PMC4550037 DOI: 10.1016/s2215-0366(15)00095-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early social deprivation can negatively affect domains of functioning. We examined psychopathology at age 12 years in a cohort of Romanian children who had been abandoned at birth and placed into institutional care, then assigned either to be placed in foster care or to care as usual. METHODS We used follow-up data from the Bucharest Early Intervention Project (BEIP), a randomised controlled trial of abandoned children in all six institutions for young children in Bucharest, Romania. In the initial trial, 136 children, enrolled between ages 6-31 months, were randomly assigned to either care as usual or placement in foster care. In this study we followed up these children at age 12 years to assess psychiatric symptoms using the Diagnostic Interview Schedule for Children (4th edition; DISC-IV). We also recruited Romanian children who had never been placed in an institution from paediatric clinics and schools in Bucharest as a comparator group who had never been placed in an institution. The primary outcome measure was symptom counts assessed through DISC-IV scores for three domains of psychopathology: internalising symptoms, externalising symptoms, and attention-deficit hyperactivity disorder (ADHD). We compared mean DISC-IV scores between trial participants and comparators who had never been placed in an institution, and those assigned to care as usual or foster care. Analyses were done by modified intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00747396. FINDINGS We followed up 110 children from the BEIP trial between Jan 27, 2011, and April 11, 2014, and 49 children as comparators who had never been placed in an institution. The 110 children who had ever been placed in an institution had higher symptom counts for internalising disorders (mean 0·93 [SD 1·68] vs 0·45 [0·84], difference 0·48 [95% CI 0·14-0·82]; p=0·0127), externalising disorders (2·31 [2·86] vs 0·65 [1·33], difference 1·66 [1·06-2·25]; p<0·0001), and ADHD (4·00 [5·01] vs 0·71 [1·85], difference 3·29 [95% CI 2·39-4·18]; p<0·0001) than did children who had never been placed in an institution. Compared with 55 children randomly assigned to receive care as usual, the 55 children in the foster-care group had fewer externalising symptoms (mean 2·89 [SD 3·00] for care as usual vs 1·73 [2·61] for foster care, difference 1·16 [95% CI 0·11 to 2·22]; p=0·0255), but symptom counts for internalising disorders (mean 1·00 [1·59] for care as usual vs 0·85 [1·78] for foster care, difference 0·15 [-0·35 to 0·65]; p=0·5681) and ADHD (mean 3·76 [4·61] for care as usual vs 4·24 [5·41] for foster care, difference -0·47 [-2·15 to 1·20; p=0·5790) did not differ. In further analyses, symptom scores substantially differed by stability of foster-care placement. INTERPRETATION Early foster care slightly reduced the risk of psychopathology in children who had been living in institutions, but long-term stability of foster-care placements is an important predictor of psychopathology in early adolescence. FUNDING National Institute of Mental Health and the John D and Catherine T MacArthur Foundation.
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Affiliation(s)
| | | | - Stacy S Drury
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Devi Miron
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Charles A Nelson
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Harvard Graduate School of Education, Cambridge, MA, USA
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87
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Misquiatti ARN, Nakaguma PG, Brito MC, Olivati AG. Desempenho de vocabulário em crianças pré-escolares institucionalizadas. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201513814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: verificar o desempenho de vocabulário de crianças institucionalizadas e comparar com o desempenho de crianças pertencentes à rede pública e particular de ensino. MÉTODOS: participaram deste estudo 16 crianças em situação de acolhimento institucional em abrigo, de ambos os gêneros, com idades entre 4 anos a 5 anos e 11 meses (grupo experimental). Para compor o grupo controle, participaram 32 crianças provenientes de escolas pública (n=16) e privada (n=16) pareadas por idade, totalizando 48 participantes. Para a verificação do desempenho de vocabulário foi utilizado o Teste de Vocabulário - ABFW que verifica a competência lexical da criança e os recursos de significação utilizados para nomear a palavra alvo. Foi realizada a análise estatística dos dados a fim de analisar diferenças entre os grupos pesquisados (Teste de Kruskal-Wallis). RESULTADOS: foi possível observar que as crianças institucionalizadas demonstraram desempenho inferior na prova de vocabulário em relação aos grupos controle, que não apresentaram grandes diferenças entre si. Cabe mencionar que todas as crianças demonstraram maior dificuldade nos campos conceituais "profissões" e "locais". CONCLUSÃO: crianças em situação de acolhimento institucional em abrigo possuem desempenho vocabulário abaixo do esperado para a idade e inferior ao desempenho de pré-escolares de escolas pública e privada que residem com suas famílias.
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88
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von Klitzing K, Döhnert M, Kroll M, Grube M. Mental Disorders in Early Childhood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:375-86; quiz 386. [PMID: 26149380 PMCID: PMC4496484 DOI: 10.3238/arztebl.2015.0375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/19/2015] [Accepted: 01/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND About 17% of all children suffer from a mental disorder in early childhood, defined as the period up to the age of 6 years. METHODS This review is based on publications retrieved by a selective search in PubMed and the Web of Science, as well as on the authors' clinical and scientific experience. RESULTS In children up to age 2, disorders of emotional and motor regulation are common (ca. 7%), as are feeding problems (25%), which persist in 2% of children to meet the diagnostic criteria for a feeding disorder. Reactive attachment disorder, a serious mental illness, has a prevalence of about 1%: it is more common among children in situations of increased risk, e.g., orphanages and foster homes. Preschool children can develop anxiety disorder and depressive disorder, as well as hyperactivity and behavioral disorders (the latter two mainly in boys). Parent training and parent-child psychotherapy have been found to be effective treatments. There is no evidence that psychotropic drugs are effective in early childhood. CONCLUSION The diagnostician should act cautiously when assigning psychopathological significance to symptoms arising in early childhood but should still be able to recognize mental disorders early from the way they are embedded in the child's interactive relationships with parents or significant others, and then to initiate the appropriate treatment. Psychotherapy in this age group is still in need of validation by efficacy studies and longitudinal studies of adequate quality.
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Affiliation(s)
- Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig
| | - Mirko Döhnert
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig
| | - Michael Kroll
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig
| | - Matthias Grube
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig
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89
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McCall RB, Groark CJ. Research on Institutionalized Children: Implications for International Child Welfare Practitioners and Policymakers. ACTA ACUST UNITED AC 2015. [DOI: 10.1037/ipp0000033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper reviews the empirical literature on the effects of institutionalization on young children’s development from the perspective of global child welfare practice and policy. It considers the characteristics of typical institutions, how to assess the quality of care in institutions, the level of physical and behavioral/mental development of infants and young children while residing in institutions, the crucial role of caregiver–child interactions in children’s development, the potential of children to developmentally improve when institutional caregiver–child interactions improve or children are transferred to families, and the influence of the quality of care on children’s development regardless of context. Several controversies are considered in a balanced fashion and from the standpoint of the nature of the evidence, such as care as typically practiced versus more ideal care, intercountry adoptions, improving institutions, and volunteers in institutions. Implications for practice and policy are identified throughout, especially factors that characterize successful large-scale attempts to transition from institutionalization to a system of family alternatives.
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90
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Brett ZH, Sheridan M, Humphreys K, Smyke A, Gleason MM, Fox N, Zeanah C, Nelson C, Drury S. A neurogenetics approach to defining differential susceptibility to institutional care. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2015; 39:150-160. [PMID: 25663728 PMCID: PMC4317330 DOI: 10.1177/0165025414538557] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
An individual's neurodevelopmental and cognitive sequelae to negative early experiences may, in part, be explained by genetic susceptibility. We examined whether extreme differences in the early caregiving environment, defined as exposure to severe psychosocial deprivation associated with institutional care compared to normative rearing, interacted with a biologically informed genoset comprising BDNF (rs6265), COMT (rs4680), and SIRT1 (rs3758391) to predict distinct outcomes of neurodevelopment at age 8 (N = 193, 97 males and 96 females). Ethnicity was categorized as Romanian (71%), Roma (21%), unknown (7%), or other (1%). We identified a significant interaction between early caregiving environment (i.e., institutionalized versus never institutionalized children) and the a priori defined genoset for full-scale IQ, two spatial working memory tasks, and prefrontal cortex gray matter volume. Model validation was performed using a bootstrap resampling procedure. Although we hypothesized that the effect of this genoset would operate in a manner consistent with differential susceptibility, our results demonstrate a complex interaction where vantage susceptibility, diathesis stress, and differential susceptibility are implicated.
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Affiliation(s)
| | | | | | - Anna Smyke
- Tulane University School of Medicine, USA
| | | | | | | | - Charles Nelson
- Boston Children's Hospital and Harvard Medical School, USA
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91
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Deviations from the expectable environment in early childhood and emerging psychopathology. Neuropsychopharmacology 2015; 40:154-70. [PMID: 24998622 PMCID: PMC4262894 DOI: 10.1038/npp.2014.165] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/10/2014] [Accepted: 06/28/2014] [Indexed: 01/17/2023]
Abstract
Current frameworks for understanding the link between early adverse childhood experiences and later negative life outcomes, including psychopathology, focus on the mediating negative impact on brain and biological systems in the developing child resulting broadly from stress and trauma. Although this approach is useful, we argue that the framework could be functionally extended by distinguishing the effects of two different types of abnormal input, both deviations from the expectable environment in early childhood. Specifically, we review the consequences of inadequate input (eg, neglect/deprivation) and harmful input (eg, abuse/trauma) on brain and biological development. We then review evidence on the differential links between each type of abnormal input to four selected domains of psychopathology (indiscriminate social behavior, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and conduct problems), and consider potential mechanisms for inadequate and harmful input to lead to these outcomes. We conclude that the careful consideration of the type of deviation from the expected environment, while acknowledging the practical difficulties in assessing this, is likely to lead to clearer understanding of the mechanism of risk for psychopathology, and that tailored approaches to prevention and intervention may be informed by considering the unique consequences of inadequate and harmful input when experienced in early childhood.
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92
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Serotonin Transporter Genotype (5HTTLPR) Moderates the Longitudinal Impact of Atypical Attachment on Externalizing Behavior. J Dev Behav Pediatr 2015; 36:409-16. [PMID: 25933228 PMCID: PMC4497925 DOI: 10.1097/dbp.0000000000000171] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To test whether genotype of the serotonin transporter-linked polymorphic region (5HTTLPR) and atypical attachment interact to predict externalizing psychopathology prospectively in a sample of children with a history of early institutional care. METHODS Caregiver report of externalizing behavior at 54 months was examined in 105 children initially reared in institutional care and enrolled in the Bucharest Early Intervention Project, a randomized controlled trial of high quality foster care. 5HTTLPR genotype, attachment status at 42 months of age (typical [secure, avoidant, or ambivalent] or atypical [disorganized-controlling, insecure-other]), and their interaction were examined as predictors of externalizing behavior at age 54 months. RESULTS 5HTTLPR genotype and atypical attachment at age 42 months interacted to predict externalizing behavior at age 54 months. Specifically, children with the s/s genotype with an atypical attachment had the highest externalizing scores. However, s/s children with a typical attachment demonstrated the lowest externalizing scores, even after controlling for intervention group status. There was no association between attachment status and externalizing behavior among children carrying at least 1 copy of the l allele. CONCLUSION These findings indicate that genetic variation in the serotonergic system moderates the association between atypical attachment status and externalizing in young children. Our findings suggest that children, as a result of genetic variability in the serotonergic system, demonstrate differential sensitivity to the attachment relationship.
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93
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MacKenzie MJ, Gearing RE, Schwalbe CS, Ibrahim RW, Brewer KB, Al-Sharaihah R. Child mental health in Jordanian orphanages: effect of placement change on behavior and caregiving. BMC Pediatr 2014; 14:316. [PMID: 25528351 PMCID: PMC4278229 DOI: 10.1186/s12887-014-0316-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/12/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To assess the mental health and behavioral problems of children in institutional placements in Jordan to inform understanding of current needs, and to explore the effects of placement change on functioning and staff perceptions of goodness-of-fit. METHODS An assessment was completed of 134 children between 1.5-12 years-of-age residing in Jordanian orphanages. The Child Behavior Checklist was used to assess prevalence rates of problems across externalizing and internalizing behavior and DSM-IV oriented subscales. Also included was caregiver perceived goodness-of-fit with each child, caregiving behavior, and two placement change-clock variables; an adjustment clock measuring time since last move, and an anticipation clock measuring time to next move. RESULTS 28% were in the clinical range for the internalizing domain on the CBCL, and 22% for the externalizing domain. The children also exhibited high levels of clinical range social problems, affective disorder, pervasive developmental disorder, and conduct problems. Internalizing problems were found to decrease with time in placement as children adjust to a prior move, whereas externalizing problems increased as the time to their next age-triggered move drew closer, highlighting the anticipatory effects of change. Both behavioral problems and the change clocks were predictive of staff perceptions of goodness-of-fit with the children under their care. CONCLUSIONS These findings add to the evidence demonstrating the negative effects of orphanage rearing, and highlight the importance of the association between behavioral problems and child-caregiver relationship pathways including the timing of placement disruptions and staff perceptions of goodness-of-fit.
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Affiliation(s)
| | | | | | - Rawan W Ibrahim
- Columbia University Middle East Research Center - Amman, 1255 Amsterdam Ave., NY, NY, USA.
| | | | - Rasha Al-Sharaihah
- Columbia University Middle East Research Center - Amman, 1255 Amsterdam Ave., NY, NY, USA.
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94
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Cruz EJSD, Dias GB, Pedroso JDS. Estudo do "Ages and Stages Questionnaires" com cuidadores de crianças institucionalizadas. PSICO-USF 2014. [DOI: 10.1590/1413-82712014019003004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Este estudo explorou o conhecimento de cuidadoras sobre o desenvolvimento de crianças em acolhimento institucional com um instrumento de triagem. Participaram deste estudo quatro crianças na faixa etária de 5 anos de idade e as cuidadoras responsáveis. O instrumento utilizado foi o Ages and Stages Questionnaires, que contém 21 questionários que envolvem seis áreas de desenvolvimento. Os resultados revelaram que a comunicação foi uma das áreas pouco pontuadas pelas crianças. Suas principais dificuldades estão em verbalizar e se concentrar nas tarefas propostas. A área da coordenação motora ampla, que envolve, entre outras coisas, o correr e pular, incentivada pelo próprio ambiente da instituição, foi considerada dentro das expectativas para o desenvolvimento e recebeu pontuação máxima de acordo com o ASQ-3. As cuidadoras como pessoas de referência para as crianças, foram essenciais para aplicação do ASQ-3, que se mostrou sensível na identificação dos problemas do desenvolvimento.
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95
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Koss KJ, Hostinar CE, Donzella B, Gunnar MR. Social deprivation and the HPA axis in early development. Psychoneuroendocrinology 2014; 50:1-13. [PMID: 25150507 PMCID: PMC4252479 DOI: 10.1016/j.psyneuen.2014.07.028] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
Abstract
Growing evidence suggests that early social deprivation impacts the activity of the hypothalamic-pituitary-adrenocortical axis. Early adverse care in the form of institutional or orphanage care provides a human model for early social deprivation. The present study examined changes in diurnal cortisol during the transition to family care in the first 2 years post-adoption. Children adopted between 15 and 36 months from institutional care were examined four times during their first 2 years post-adoption (N=58). Comparison groups included same-aged peers reared in their birth families (N=50) and children adopted during their first year from overseas foster care (N=47). Children provided daily cortisol samples at roughly 2, 9, 17, and 25 months post-adoption. Post-institutionalized and post-foster care children exhibited less steep diurnal cortisol compared to non-adopted same-aged peers; these differences did not diminish across the 2 year period. For post-institutionalized children, lower social care quality in institutions was associated with less steep cortisol slopes. Lastly, shallower diurnal cortisol was a mediator between adoption status and increased behavioral problems 2 years post-adoption. Consistent with the non-human primate literature, early social deprivation may contribute to early programming of the HPA axis.
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Affiliation(s)
- Kalsea J Koss
- Institute of Child Development, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Camelia E Hostinar
- Institute for Policy Research, Northwestern University, Evanston, IL 60208, USA
| | - Bonny Donzella
- Institute of Child Development, University of Minnesota, Minneapolis, MN 55455, USA
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, Minneapolis, MN 55455, USA.
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96
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Baptista J, Belsky J, Marques S, Silva JR, Oliveira P, Mesquita A, Martins C, Soares I. The interactive effect of maltreatment in the family and unstable institutional caregiving in predicting behavior problems in toddlers. CHILD ABUSE & NEGLECT 2014; 38:2072-2079. [PMID: 25459985 DOI: 10.1016/j.chiabu.2014.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 06/04/2023]
Abstract
The current study extends research on the effects of institutionalization, most notably by examining whether-and how-both pre-institutional maltreatment in the family and the stability and consistency of institutional care interact to shape emotional and behavioral development. Fifty Portuguese children, placed in residential institutions when 8 days to 26 months of age, were evaluated using the Child Behavior Checklist when aged 18-31 months. Caregiver-rated internalizing and externalizing behavior problems proved to be unrelated to both early family and institutional experiences, as main effects, but the interaction of these factors significantly predicted externalizing problems: a history of maltreatment in the family coupled with unstable institutional caregiving arrangements predicted especially elevated levels of externalizing problems. Results are discussed in terms of the importance of more distal and proximate developmental experiences.
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Affiliation(s)
| | - Jay Belsky
- University of California, Davis, CA, USA
| | | | | | | | - Ana Mesquita
- School of Psychology, University of Minho, Portugal
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97
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Mbiya Muadi F, Mampunza S, Symann S, Habimana L, D’Hoore W, Malengreau M, Hermans D, Aujoulat I, Charlier-Mikolajczak D. Attachement et développement des enfants abandonnés vivant en institution résidentielle à Kinshasa. Arch Pediatr 2014; 21:1159-66. [DOI: 10.1016/j.arcped.2014.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/31/2013] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
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98
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Abstract
It is a truism to say that primates develop, but it is also important to acknowledge that development occurs across many domains, including motor behavior, socioemotional behavior, communication, and cognition. In this review, we focus on those aspects of development that impact social cognition outcomes in infancy. Triadic engagements, such as those of joint attention, cooperation, and intentional communication, develop in the first year of life in chimpanzees and humans. Joint attention, for example, occurs when infants coordinate their attention to a social partner while also attending to an object or event. Hominoids are strongly influenced by experiences during early development, especially experiences that are foundational for these coordinated triadic engagements. Purported species differences in triadic engagements are highlighted in current evolutionary theories of primate social cognition, but conclusions about species differences are unfounded when development is ignored. Developmental experiences must be matched, controlled, or systematically varied in experimental designs that make cross-species comparisons. Considerations of development, across species and across rearing experiences, would contribute to more accurate evolutionary theories of primate social cognition.
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Affiliation(s)
- Kim A. Bard
- Psychology Department, University of Portsmouth, Portsmouth, Hampshire PO1 2DY, United Kingdom
| | - David A. Leavens
- School of Psychology, University of Sussex, Falmer, East Sussex BN1 9QH, United Kingdom
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99
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Sheridan MA, McLaughlin KA. Dimensions of early experience and neural development: deprivation and threat. Trends Cogn Sci 2014; 18:580-585. [PMID: 25305194 DOI: 10.1016/j.tics.2014.09.001] [Citation(s) in RCA: 364] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/18/2014] [Accepted: 09/04/2014] [Indexed: 12/17/2022]
Abstract
Over the past decade, a growing area of research has focused on adverse childhood experiences (ACEs) and their impacts on neural and developmental outcomes. Work in the field to-date has generally conceptualized ACEs in terms of exposure to stress while overlooking the underlying dimensions of environmental experience that may distinctly impact neural development. Here, we propose a novel framework that differentiates between deprivation (absence of expected cognitive and social input) and threat (presence of a threat to one's physical integrity). We draw support for the neural basis of this distinction from studies on fear learning and sensory deprivation in animals to highlight potential mechanisms through which experiences of threat and deprivation could affect neural structure and function in humans.
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Affiliation(s)
- Margaret A Sheridan
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School
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100
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Oliveira PS, Fearon RMP, Belsky J, Fachada I, Soares I. Quality of institutional care and early childhood development. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2014. [DOI: 10.1177/0165025414552302] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Institutional rearing adversely affects children’s development, but the extent to which specific characteristics of the institutional context and the quality of care provided contribute to problematic development remains unclear. In this study, 72 preschoolers institutionalised for at least 6 months were evaluated by their caregiver using the Child Behavior Checklist and the Disturbances of Attachment Interview. Distal and proximate indices of institutional caregiving quality were assessed using both staff reports and direct observation. Results revealed that greater caregiver sensitivity predicted reduced indiscriminate behaviour and secure-base distortions. A closer relationship with the caregiver predicted reduced inhibited attachment behaviour. Emotional and behavioural problems proved unrelated to caregiving quality. Results are discussed in terms of (non)-shared caregiving factors that influence institutionalised children’s development.
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