The Neurobiological Toll of Early Human Deprivation

Language development of internationally adopted children: Adverse early experiences outweigh the age of acquisition effect

We compared English language and cognitive skills between internationally adopted children (IA; mean age at adoption=2.24, SD=1.8) and their non-adopted peers from the US reared in biological families (BF) at two time points. We also examined the relationships between outcome measures and age at initial institutionalization, length of institutionalization, and age at adoption. On measures of general language, early literacy, and non-verbal IQ, the IA group performed significantly below their age-peers reared in biological families at both time points, but the group differences disappeared on receptive vocabulary and kindergarten concept knowledge at the second time point. Furthermore, the majority of children reached normative age expectations between 1 and 2 years post-adoption on all standardized measures. Although the age at adoption, age of institutionalization, length of institutionalization, and time in the adoptive family all demonstrated significant correlations with one or more outcome measures, the negative relationship between length of institutionalization and child outcomes remained most robust after controlling for the other variables. Results point to much flexibility and resilience in children's capacity for language acquisition as well as the potential primacy of length of institutionalization in explaining individual variation in IA children's outcomes.

LEARNING OUTCOMES

(1) Readers will be able to understand the importance of pre-adoption environment on language and early literacy development in internationally adopted children. (2) Readers will be able to compare the strength of the association between the length of institutionalization and language outcomes with the strength of the association between the latter and the age at adoption. (3) Readers will be able to understand that internationally adopted children are able to reach age expectations on expressive and receptive language measures despite adverse early experiences and a replacement of their first language with an adoptive language.

Twitch-related and rhythmic activation of the developing cerebellar cortex

The cerebellum is a critical sensorimotor structure that exhibits protracted postnatal development in mammals. Many aspects of cerebellar circuit development are activity dependent, but little is known about the nature and sources of the activity. Based on previous findings in 6-day-old rats, we proposed that myoclonic twitches, the spontaneous movements that occur exclusively during active sleep (AS), provide generalized as well as topographically precise activity to the developing cerebellum. Taking advantage of known stages of cerebellar cortical development, we examined the relationship between Purkinje cell activity (including complex and simple spikes), nuchal and hindlimb EMG activity, and behavioral state in unanesthetized 4-, 8-, and 12-day-old rats. AS-dependent increases in complex and simple spike activity peaked at 8 days of age, with 60% of units exhibiting significantly more activity during AS than wakefulness. Also, at all three ages, approximately one-third of complex and simple spikes significantly increased their activity within 100 ms of twitches in one of the two muscles from which we recorded. Finally, we observed rhythmicity of complex and simple spikes that was especially prominent at 8 days of age and was greatly diminished by 12 days of age, likely due to developmental changes in climbing fiber and mossy fiber innervation patterns. All together, these results indicate that the neurophysiological activity of the developing cerebellum can be used to make inferences about changes in its microcircuitry. They also support the hypothesis that sleep-related twitches are a prominent source of discrete climbing and mossy fiber activity that could contribute to the activity-dependent development of this critical sensorimotor structure.

The science of early adversity: is there a role for large institutions in the care of vulnerable children?

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.

Perspectiva Cultural del Desarrollo Infantil en las Instituciones de Protección

Tradicionalmente, el desarrollo de los niños que viven y crecen en los contextos de protección se ha entendido a partir de las perspectivas normativas de desarrollo. Esto ha llevado a que se asuma el desarrollo del niño en acogimiento residencial con la misma lógica implementada para aquellos niños criados por sus padres, lo cual conduce a un desconocimiento del contexto cultural inherente al proceso de desarrollo infantil. Reconocer la relación entre la cultura institucional y el desarrollo del niño que vive en un contexto de protección implica considerar el proceso de constitución entre el desarrollo y el trasfondo cultural. Ello exige una aproximación metodológica diferente a la tradicional.

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

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

Myoclonic Twitching and Sleep-Dependent Plasticity in the Developing Sensorimotor System

As bodies grow and change throughout early development and across the lifespan, animals must develop, refine, and maintain accurate sensorimotor maps. Here we review evidence that myoclonic twitches-brief and discrete contractions of the muscles, occurring exclusively during REM (or active) sleep, that result in jerks of the limbs-help animals map their ever-changing bodies by activating skeletal muscles to produce corresponding sensory feedback, or reafference. First, we highlight the spatiotemporal characteristics of twitches. Second, we review findings in infant rats regarding the multitude of brain areas that are activated by twitches during sleep. Third, we discuss evidence demonstrating that the sensorimotor processing of twitches is different from that of wake movements; this state-related difference in sensorimotor processing provides perhaps the strongest evidence yet that twitches are uniquely suited to drive certain aspects of sensorimotor development. Finally, we suggest that twitching may help inform our understanding of neurodevelopmental disorders, perhaps even providing opportunities for their early detection and treatment.

Mothers' early depressive symptoms predict children's low social competence in first grade: mediation by children's social cognition

BACKGROUND

This study examined whether social-cognitive processes in children mediate relations between mothers' depressive symptoms across the first 3 years and children's first-grade social competence. Three maladaptive cognitions were examined: self-perceived social inadequacy, hostile attribution, and aggressive response generation.

METHOD

One thousand three hundred and sixty-four mothers reported depressive symptoms across early development, first-grade children reported target social cognitions, and children's first-grade social competence was observed and reported by multiple informants.

RESULTS

Findings demonstrated that (a) mothers' average depressive symptoms from 6 to 36 months predicted children's maladaptive social cognition in first grade, (b) low mother-child responsiveness mediated this relation, and (c) maladaptive social cognition mediated relations between mothers' early depressive symptoms and low first-grade social competence independent of later depressive symptoms.

CONCLUSION

When mothers' depressive symptoms occur early in development, they may set in motion low-responsive dyadic patterns that promote children's maladaptive social cognition and, as a result, low social competence.

Deviations from the expectable environment in early childhood and emerging psychopathology

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.

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

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

Adoption: biological and social processes linked to adaptation

Children join adoptive families through domestic adoption from the public child welfare system, infant adoption through private agencies, and international adoption. Each pathway presents distinctive developmental opportunities and challenges. Adopted children are at higher risk than the general population for problems with adaptation, especially externalizing, internalizing, and attention problems. This review moves beyond the field's emphasis on adoptee-nonadoptee differences to highlight biological and social processes that affect adaptation of adoptees across time. The experience of stress, whether prenatal, postnatal/preadoption, or during the adoption transition, can have significant impacts on the developing neuroendocrine system. These effects can contribute to problems with physical growth, brain development, and sleep, activating cascading effects on social, emotional, and cognitive development. Family processes involving contact between adoptive and birth family members, co-parenting in gay and lesbian adoptive families, and racial socialization in transracially adoptive families affect social development of adopted children into adulthood.

Inhibitory control and working memory in post-institutionalized children

Inhibitory control and working memory were examined in post-institutionalized (PI) children adopted into United States families from Russian institutions. The PI sample originated from institutions that were less severely depriving than those represented in previous studies and approximated the level of psychosocial deprivation, which is characterized by adequate physical resources but a lack of consistent and responsive caregiving. PI children (N = 75; 29 male) ranged in age from 8-17 years (M = 12.97; SD = 3.03) and were grouped according to whether they were adopted after 14 months or before 9 months. A non-adopted comparison group (N = 133; 65 male) ranged in age from 8-17 years (M = 12.26; SD = 2.75). PI children adopted after 14 months of age displayed poorer performance on the stop-signal and spatial span tasks relative to PI children adopted before 9 months of age after controlling for age at assessment. The two PI groups did not differ in their performance on a spatial self-ordered search task. Older-adopted PI children also showed poorer spatial span task performance compared to non-adopted children, but younger-adopted PI children did not. Task performance was significantly associated with parent-rated hyperactive-impulsive behavior in everyday contexts. These findings suggest that exposure to prolonged early institutional deprivation may be linked with inhibitory control and working memory difficulties years after adoption.

Systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care

OBJECTIVES

This article reviews the available evidence regarding the efficacy, effectiveness, ethics, and sustainability of approaches to strengthen systems to care for and protect children living outside family care in low- and middle-income countries.

METHOD

For trafficked children, children of and on the street, children of conflict/disaster, and institutionalized children, a systems framework approach was used to organize the topic of sustainable approaches in low- and middle-income countries and addresses the following: legislation, policies, and regulations; system structures and functions (formal and informal); and continuum of care and services. The article draws on the findings of a focal group convened by the U.S. Government Evidence Summit: Protecting Children Outside of Family Care (December 12-13, 2011, Washington, DC), tasked with reviewing the literature on systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care in low- and middle-income country contexts. The specific methodology for the review is described in the commentary paper (Higgs, Zlidar, & Balster, 2012) that accompanies these papers.

RESULTS

For the most part, the evidence base in support of sustainable long-term care for the populations of interest is relatively weak, with some stronger but unreplicated studies. Some populations have been studied more thoroughly than others, and there are many gaps. Most of the existing studies identify population characteristics, needs, and consequences of a lack of systemic services to promote family-like care. There is some evidence of the effectiveness of laws and policies, as well as some evidence of service effectiveness, in improving outcomes for children outside of family care.

CONCLUSIONS

Despite the weaknesses and gaps of the existing research, there is a foundation of research for going forward, which should focus on developing and implementing systems for these most vulnerable children. The evidence reviewed indicates that child protection systems should aim for appropriate, permanent family care (including reunification, adoption, kinship care, or kafalah) for children in order to secure the best environment for a child's developmental prospects. Evidence also suggests that the quality and duration of care, including both permanent family care and alternative care, are important regardless of setting. The diversity of political, socioeconomic, historical, regional, community, and cultural contexts in which child protection systems operate need to be taken into account during programming and research design.