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

Associations of Duration of Preadoption Out-of-home Care, Genetic Risk for Schizophrenia Spectrum Disorders and Adoptive Family Functioning with Later Psychiatric Disorders of Adoptees

The objective was to examine the impacts of duration of preadoption out-of-home care and adoptive family functioning on later psychiatric morbidity of adoptees with high (HR) and low (LR) genetic risk for schizophrenia spectrum disorders. The study uses nationwide data from the Finnish Adoptive Family Study of Schizophrenia. The study population in this substudy consisted of 43 h adoptees and 128 LR adoptees. Of these adoptees, 90 had spent 0-6 months and 81 over 6 months in preadoption out-of-home care. The family functioning of adoptive families was assessed based on Global Family Ratings and psychiatric disorders on DSM-III-R criteria. The results showed that among the adoptees with over 6 months in preadoption out-of-home care, the likelihood for psychiatric disorders was significantly increased in HR adoptees compared to LR adoptees. In adoptees with 6 months or less in preadoption out-of-home care, an increased likelihood for psychiatric disorders was found among those living in adoptive families with dysfunctional processes. These findings indicate that especially for HR children, a well-functioning early caregiving environment is crucial in terms of subsequent mental wellbeing. The results emphasize that when adoption is necessary, early placement and well-functioning adoptive family environment are beneficial to children.

The association between adverse childhood experiences and sensory impairment in middle-aged and older adults: Evidence from a nationwide cohort study in China

BACKGROUND

Sensory impairment (SI), as prevalent condition among the elderly, presents a substantial public health burden.

OBJECTIVES

To investigate the association of cumulative and individual adverse childhood experiences (ACEs) with SI.

METHODS

Chinese residents aged 45 years and above were recruited from the China Health and Retirement Longitudinal Study 2011-2018, using stratified random sampling. The number of ACEs was classified into "0 ACE", "1 to 3 ACEs", and "≥4 ACEs". SI was assessed with self-rated visual or hearing status. SI categories included single sensory impairment (SSI), which can be divided into single vision impairment and single hearing impairment. Possessing both vision impairment and hearing impairment was considered as dual sensory impairment (DSI). Longitudinal SI progression encompassed "maintained no SI", "no SI to SSI", "no SI to DSI", "maintained SSI", "SSI to DSI", and "maintained DSI". Logistic regression and restricted cubic splines models were used for analysis.

RESULTS

A total of 6812 participants entered the cross-sectional analysis and 5299 entered the longitudinal analysis. Compared to 0 ACE, ≥4 ACEs had a positive association with DSI (OR = 1.57, 95 % CI = 1.20-2.06) but not with single vision impairment (OR = 1.17, 95 % CI: 0.88-1.55) or single hearing impairment (OR = 1.10, 95 % CI: 0.71-1.70), and this association was observed only in females (OR = 1.73, 95 % CI = 1.20-2.51). A linear association was found between cumulative ACEs and both single vision impairment (p = 0.044) and DSI (p < 0.001). Compared to 0 ACE, ≥4 ACEs was associated with a higher risk of progression from SSI to DSI (OR = 1.71, 95 % CI = 1.03-2.84), and the maintained DSI (OR = 2.23, 95 % CI =1.37-3.65).

CONCLUSION

ACEs were found to be associated with an increased risk and more severe progression of SI later in life. It is imperative to address different types of ACE and incorporate sex-specific measures to mitigate the enduring sensory impact of ACEs.

Mother-infant self- and interactive contingency at four months and infant cognition at one year: A view from microanalysis

Although a considerable literature documents associations between early mother-infant interaction and cognitive outcomes in the first years of life, few studies examine the contributions of contingently coordinated mother-infant interaction to infant cognitive development. This study examined associations between the temporal dynamics of the contingent coordination of mother-infant face-to-face interaction at 4 months and cognitive performance on the Bayley Scales of Infant Development at age one year in a sample of (N = 100) Latina mother-infant pairs. Split-screen videotaped interactions were coded on a one second time base for the communication modalities of infant and mother gaze and facial affect, infant vocal affect, and mother touch. Multi-level time-series models evaluated self- and interactive contingent processes in these modalities and revealed 4-month patterns of interaction associated with higher one-year cognitive performance, not identified in prior studies. Infant and mother self-contingency, the moment-to-moment probability that the individual's prior behavior predicts the individual's future behavior, was the most robust measure associated with infant cognitive performance. Self-contingency findings showed that more varying infant behavior was optimal for higher infant cognitive performance, namely, greater modulation of negative affect; more stable maternal behavior was optimal for higher infant cognitive performance, namely, greater likelihood of sustaining positive facial affect. Although interactive contingency findings were sparse, they showed that, when mothers looked away, or dampened their faces to interest or mild negative facial affect, infants with higher 12-month cognitive performance were less likely to show negative vocal affect. We suggest that infant ability to modulate negative affect, and maternal ability to sustain positive affect, may be mutually reinforcing, together creating a dyadic climate that is associated with more optimal infant cognitive development.

Behavioral, cognitive, and socioemotional pathways from early childhood adversity to BMI: Evidence from two prospective, longitudinal studies

Childhood adversity is associated with higher adult weight, but few investigations prospectively test mechanisms accounting for this association. Using two socioeconomically high-risk prospective longitudinal investigations, the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA; N = 267; 45.3% female) and the Fragile Families and Child Wellbeing Study (FFCWS; n = 2,587; 48.5% female), pathways between childhood adversity and later body mass index (BMI) were tested using impulsivity, emotion dysregulation, and overeating as mediators. Childhood adversity from 0 to 5 years included four types of adversities: greater unpredictability, threat/abuse, deprivation/neglect, and low socioeconomic status. Parents reported on child impulsivity, emotion dysregulation, and overeating. Height and weight were self-reported and measured at 32 and 37 years in MLSRA and at 15 years in FFCWS. FFCWS results indicated that threat, deprivation, and low socioeconomic status predicted greater impulsivity and emotion dysregulation at 5 years, which in turn predicted greater overeating at 9 years and higher BMI z-score at 15 years. Early unpredictability in FFCWS predicted higher BMI through greater impulsivity but not emotion dysregulation at age 5. MLSRA regression results replicated the threat/abuse → emotion dysregulation → overeating → higher BMI pathway. These findings suggest that different dimensions of early adversity may follow both similar and unique pathways to predict BMI.

Effects of childhood institutionalization on semantic processing and its neural correlates persist into adolescence and adulthood

Individuals raised in institutionalized care settings are more likely to demonstrate developmental deficits than those raised in biological families. One domain that is vulnerable to the impoverished environments characteristic of some institutionalized care facilities is language development. We used EEG to assess ERPs and source-localized event-related spectral perturbations (ERSPs) associated with semantic processing at different levels of picture-word conflict and low versus high word frequency. Additionally, we assessed behavioral language ability (a synonyms task) and IQ. Participants (N = 454) were adolescents and adults with a history of institutionalized care (N = 187) or raised in biological families (N = 267), both recruited from secondary educational settings to approximately match the groups on age and education. Results indicate that individuals with a history of institutionalization are less accurate at judging whether semantic information in a spoken word matches an image. Additionally, those with a history of institutionalization show reduced cognitive control of conflict and more reactive N400 ERPs and beta ERSPs when handling picture-word conflict, especially in the left hemisphere. Frontal theta is related to semantic and conflict processing; however, in this study it did not vary with institutionalization.

Neural correlates of face familiarity in institutionalised children and links to attachment disordered behaviour

BACKGROUND

One of the most well-documented sequelae of early maltreatment and institutionalisation is attachment problems, including behaviours under the labels of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). Despite growing evidence of the neurobiological effects of institutionalisation, the neural correlates of these behavioural patterns are largely unknown.

METHODS

The current study examined effects of both institutionalisation in general and attachment disordered behaviour, in particular, on brain-based markers of face processing, in 100 Portuguese children (70 currently institutionalised, 30 continuously raised by their families). Children's neural processing of caregiver's and stranger's faces was assessed with Event-Related Potentials (ERPs).

RESULTS

Compared to children from the community, institutionalised children showed smaller amplitudes in the N170, to both stranger and caregiver faces. Amongst the institutionalised group, living in a setting with a higher children-to-caregivers' ratio was associated with smaller P400 amplitudes. The display of DSED symptoms was associated with a smaller P1 to both faces, as well as a reduced differentiation between faces in P400 amplitudes and smaller P400 to the stranger's face. In contrast, RAD symptoms were not associated with any ERP measures.

CONCLUSIONS

Results replicate previously reported hypoactivation in institutionalised children, in a less-globally deprived setting than past work, indicating that such a pattern is associated with lack of individualised care and increased symptoms of DSED.

Symptoms of Posttraumatic Stress and Sexual Concerns: The Intermediary Effects of Executive Functioning on Profiles of Youth Who Have Sexually Harmed

There are demonstrated links in the general population between developmental adversity, associated trauma symptoms, and executive functioning difficulties in children and youth. However, research on links among these indicators and their relationship to antisocial behavior more broadly in samples of youth who have sexually harmed is only beginning to emerge. Some research indicates that intermediary factors like sexual concerns may be critical in understanding this population. This study explored relationships between trauma symptoms, sexual concerns, executive functioning, and their relationship to non-sexual delinquency in a sample of 196 youth who committed sexual harm. Structural equation modeling revealed numerous direct and indirect effects on the path to delinquency and that executive functioning plays a key role among those with serious sexual concerns. The results are contextualized and implications are discussed.

Metabolic proteins at birth predict early childhood mental health symptoms

Child mental health disorders are the leading cause of disability in children and adolescents worldwide. Biological correlates predict psychosocial outcomes throughout human development; however, less is known about metabolic proteins. Drawing from a longitudinal birth cohort study, Born in Bradford (BiB), we examined the role of infant metabolic proteins at birth in predicting early childhood mental health symptoms at 3 and 5 years. We found that higher leptin predicted more prosocial behavior at age 3. Additionally, a higher leptin-to-adiponectin ratio predicted increased total symptom difficulties. At age 5, we found that higher adiponectin predicted a decreased likelihood of being rated by teachers as meeting or exceeding expectations in the domain of "managing feelings and behaviors" and marginally predicted lower competency in "making relationships" on national developmental milestone evaluations. To our knowledge, this is among the first few studies to prospectively predict mental health symptoms from cord blood metabolic proteins, and the first examining this association with a leptin-to-adiponectin ratio. Our results provide support for the possibility that metabolic proteins at birth forecast risk for mental health symptoms in early childhood.

[Personality Models in the Context of Child and Adolescent Psychiatry - Development, Change, Stability and Research Perspectives]

Personality models play an important role for the etiological understanding of abnormal development in clinical settings. In this selective review, relevant personality models are presented and, in particular, their developmental dynamics and adaptability over the life span, starting in childhood, are considered in detail. The focus is on the developmental psychopathological perspective of processes of ego-resiliency and self-regulation between the poles of disposition and social environment. This is particularly obvious in the discussion of developmental path models of personality dysfunction with experiences of abuse or disorganized attachment in the child's history. Psychopathologically, an ongoing impairment of self-regulation often results in stable patterns of maladaptation, which leads in the case of purely symptomatic treatment usually only to temporary behavioral modifications. On the other hand, the changeability of pathological personality traits through the use of targeted intervention approaches will favour of a positive outcome and contradicts a deterministic stability of personality characteristics. For future research perspectives in developmental psychopathology, various theoretical personality constructs are discussed and linked to clinical observations.

Relationships Among Childhood Maltreatment, Limbic System Dysfunction, and Eating Disorders in College Women

The mechanisms linking childhood maltreatment and eating pathology are not fully understood. We examined the mediating role of limbic system dysfunction in the relationships between three forms of childhood maltreatment (parental psychological maltreatment, parental physical maltreatment, and parental emotional neglect) and eating disorder symptoms. A convenience sample of college women (N = 246, M age = 19.62, SD = 2.41) completed measures of maltreatment (Parent-Child Conflict Tactics Scales and the Parental Bonding Instrument), limbic system dysfunction (Limbic System Questionnaire), and eating pathology (Eating Disorder Examination Questionnaire). We hypothesized that there would be an indirect effect of each type of childhood maltreatment on eating disorder symptoms via limbic system irritability. Results generally supported the hypotheses. Examination of the individual paths that defined the indirect effect indicated that higher reported childhood maltreatment was associated with greater limbic irritability symptoms, and higher limbic irritability symptomatology was related to higher total eating disorder scores. There were no significant direct effects for any of the proposed models. Findings are in line with research supporting the role of limbic system dysfunction as a possible pathway in the maltreatment-eating disorder link. Given that limbic system dysfunction may underlie behavioral symptoms of eating disorders, efforts targeting limbic system dysfunction associated with child maltreatment might best be undertaken at an early developmental stage, although interventions for college women struggling with eating disorders are also crucial.

The impact of childhood deprivation on adult neuropsychological functioning is associated with ADHD symptom persistence

BACKGROUND

Institutional deprivation in early childhood is associated with neuropsychological deficits in adolescence. Using 20-year follow-up data from a unique natural experiment - the large-scale adoption of children exposed to extreme deprivation in Romanian institutions in the 1980s -we examined, for the first time, whether such deficits are still present in adulthood and whether they are associated with deprivation-related symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

METHODS

Adult neuropsychological functioning was assessed across five domains (inhibitory control, emotion recognition, decision-making, prospective memory and IQ) in 70 previously institutionalized adoptees (mean age = 25.3, 50% female) and 22 non-deprived UK adoptees (comparison group, mean age = 24.6, 41% female). ADHD and ASD symptoms were assessed using parent-completed questionnaires.

RESULTS

Early institutionalization was associated with impaired performance on all tasks in adulthood. Prospective memory deficits persisted after controlling for IQ. ADHD and ASD symptoms were positively correlated. After controlling for ASD symptoms, ADHD symptoms remained associated with deficits in IQ, prospective memory, proactive inhibition, decision-making quality and emotion recognition. ASD symptoms were not independently associated with neuropsychological deficits when accounting for their overlap with ADHD symptoms. Multiple regression analysis revealed that the link between childhood deprivation and adult ADHD symptoms was statistically explained by deprivation-related differences in adult IQ and prospective memory.

CONCLUSIONS

These results represent some of the most compelling evidence to date of the enduring power of early, time-limited childhood adversity to impair long-term neuropsychological functioning across the lifespan - effects that are linked specifically to deprivation-related adult ADHD symptoms.

Parents' Acceptance of Educational Technology: Lessons From Around the World

One of the long-term lessons from the school closures due to the global pandemic COVID 19, is that technology and parental engagement are the best levers to access education so as to bridge the achievement gap between socially disadvantaged children and their peers. However, using technology is not as simple as bringing equipment into the school and home and initiating its usage; these are just the first steps into a more complex and ambitious achievement of using technology as a catalyst for a shift toward new learning models in remote and hybrid settings. A theoretical framework based on the theory of acceptance and use of technology and social cognitive learning theory was used to analyse data from a survey completed by 4,600 parents from 19 countries during the national lockdowns in 2020. Regression models and thematic analysis of open-ended responses were employed to identify factors that contribute to parental acceptance and use of technology in support of their children’s learning. Our results show that parents are more engaged in children’s learning when well-structured technological tools are provided or suggested by schools, and when parents are socially influenced by the opinions of other parents, teachers, children, the general public, relatives, etc. Conversely, they are less engaged when they perceive the technological tools to be challenging and beyond their knowledge or skills. The study’s findings have practical implications for governments and school leaders, who need to be aware of the factors likely to determine the use of technology at home and take action to meet parents’ needs when using technology to support learning.

Is early life adversity a trigger towards inflammageing?

There are many 'faces' of early life adversity (ELA), such as childhood trauma, institutionalisation, abuse or exposure to environmental toxins. These have been implicated in the onset and severity of a wide range of chronic non-communicable diseases later in life. The later-life disease risk has a well-established immunological component. This raises the question as to whether accelerated immune-ageing mechanistically links early-life adversity to the lifelong health trajectory resulting in either 'poor' or 'healthy' ageing. Here we examine observational and mechanistic studies of ELA and inflammageing, highlighting common and distinct features in these two life stages. Many biological processes appear in common including reduction in telomere length, increased immunosenescence, metabolic distortions and chronic (viral) infections. We propose that ELA shapes the developing immune, endocrine and nervous system in a non-reversible way, creating a distinct phenotype with accelerated immunosenescence and systemic inflammation. We conclude that ELA might act as an accelerator for inflammageing and age-related diseases. Furthermore, we now have the tools and cohorts to be able to dissect the interaction between ELA and later life phenotype. This should, in the near future, allow us to identify the ecological and mechanistic processes that are involved in 'healthy' or accelerated immune-ageing.

Hyper- and hypo-cortisol functioning in post-institutionalized adolescents: The role of severity of neglect and context

Understanding the developmental timing of stress exposure may help inform mechanisms underlying how stress "gets under the skin" and influences the stress response system, including the HPA axis and its end-product cortisol. Early adversity may be particularly detrimental; however, it is difficult to disentangle the timing of adversity from its cumulative burden because there is typically high continuity between early and later adversity. Moreover, context and the different stressors inherent in various contexts may interact with stress exposure to influence psychophysiological functioning. To address this issue, we examined adolescents who had been reared in institutions and suffered neglect or social deprivation ranging from approximately six months to several years of life prior to adoption into U.S. homes. We focused on the stress hormone cortisol because it can reflect continued regulatory problems in youth, even years after youth transition to typical homes. We examined cortisol morning levels and diurnal rhythms across multiple contexts (home, school, lab) on 5 separate days in 41 post-institutionalized youth and 78 comparison youth. Employing hierarchical linear modeling, we found that when assessed in the lab, post-institutionalized (PI) youth displayed lower morning cortisol levels and flatter diurnal slopes than the control youth. Yet at home, PI youth displayed higher morning cortisol levels than the control youth. In addition to group effects, we also examined severity of early adversity and found that PI kids who had endured the most severe early adversity displayed lower home cortisol levels than controls. No significant predictors of diurnal cortisol on school days were identified. These data fit with the notion that the HPA axis is impacted by early adversity, even years after adoption, and with emerging theories that postulate that stress physiology calibrates within youth to help them adapt to their context. In the case of severe early adversity, the cost of such adaptation may not be desirable. It also highlights the important role of context when assessing HPA axis activity, particularly in post-institutionalized youth.

Developmental and behavioral profile in a domestic adoptees sample: a new challenge for the pediatrician

BACKGROUND

The aim of this study is to investigate the changes of developmental and behavioral profile in a domestic adoptees sample.

METHODS

Thirty-six domestic adoptive families were recruited, resulting in a sample of 39 children. Families were sent a general questionnaire for collecting data related to the children demographic variables, infant's background (time spent in institutional care, age at adoption), children's health status and anthropometric measures at T<inf>0,</inf> T<inf>1</inf>, T<inf>2</inf>, and T<inf>3</inf>. Moreover, the Infant Behavior Questionnaire-Revised Very Short Form and a modified version of parent-report of Child Behavior Checklist were used to assess temperament and to detect behavioral problems.

RESULTS

As regards the psychopathological evaluation, behavior problems were more common in older children, especially among girls. In particular they exhibited a higher frequency of internalizing problems versus externalizing.

CONCLUSIONS

Children in foster care suffer discontinuity of care that negatively affects their emotional and physical development. It is important for pediatricians to be aware of the special needs of adopted children, providing adequate support to adoptive families.

Overlapping Neurobiological Substrates for Early-Life Stress and Resilience to Psychosis

Early-life stress, such as childhood maltreatment, is a well-known etiological factor in psychopathology, including psychosis. Exposure to early-life stress disrupts the neurodevelopment of widespread brain systems, including key components of the hypothalamic-pituitary-adrenal axis stress response, such as the amygdala, hippocampus, and medial prefrontal cortex, as well as key components of the brain's reward system, such as the nucleus accumbens and orbitofrontal cortex. These disruptions have a considerable impact on the function of emotion and reward circuitry, which play a central role in the emergence and severity of psychosis. While this overlap may provide insight into the pathophysiology of psychosis, it also provides unique opportunities to elucidate neurobiological substrates that may promote resilience to psychosis. In this review, we discuss the hypothalamic-pituitary-adrenal axis stress response, discuss the disruption in the neurodevelopment of emotion and reward processing associated with early stress exposures, and examine how this circuitry may contribute to resilience to psychotic disorders.

In-utero determinants of adult depression: evidence from the 1918 flu pandemic

Social scientists have dealt only glancing with potential in-utero determinants of mental health. This study looks at the enduring consequences of gestational exposure to the 1918 flu pandemic for adult depression. It does so using data collected in the first wave of the National Health and Nutrition Examination Survey (1971-1975), corresponding to when those exposed in-utero were in their early to mid-50s. The results indicate very strong effects of in-utero exposure on depression. These effects are only found, however, among men. The effects are sufficiently large to eliminate sex differences in major depression within a cohort: among those born in 1919, the prevalence of major depression is about 1 in 5 for both men and women. Additional analyses further clarify the relationship, showing effects of in-utero exposure across the full spectrum and syndrome of depressive symptoms. In addition, the effects are stronger for symptoms related to depression than for symptoms related to schizophrenia. Additional analyses show that the effect of exposure is reduced somewhat when adjusting for later socioeconomic disadvantages. In addition, the effect is reduced when controlling for broader dimensions of physical health. Yet neither of these relationships explains the effects of exposure altogether.

Touching the social robot PARO reduces pain perception and salivary oxytocin levels

Human-human social touch improves mood and alleviates pain. No studies have so far tested the effect of human-robot emotional touch on experimentally induced pain ratings, on mood and on oxytocin levels in healthy young adults. Here, we assessed the effect of touching the robot PARO on pain perception, on mood and on salivary oxytocin levels, in 83 young adults. We measured their perceived pain, happiness state, and salivary oxytocin. For the 63 participants in the PARO group, pain was assessed in three conditions: Baseline, Touch (touching PARO) and No-Touch (PARO present). The control group (20 participants) underwent the same measurements without ever encountering PARO. There was a decrease in pain ratings and in oxytocin levels and an increase in happiness ratings compared to baseline only in the PARO group. The Touch condition yielded a larger decrease in pain ratings compared to No-Touch. These effects correlated with the participants' positive perceptions of the interaction with PARO. Participants with higher perceived ability to communicate with PARO experienced a greater hypoalgesic effect when touching PARO. We show that human-robot social touch is effective in reducing pain ratings, improving mood and - surprisingly - reducing salivary oxytocin levels in adults.

The neurocognitive profiles of children adopted from care and their emotional and behavioral problems at home and school

Adoptees' mental health problems in childhood and later life are well described, but little attention has been paid to domestically adopted children's emotional and behavioral problems and neurocognitive profiles. The aim of this study was to describe the neurocognitive profiles of domestically adopted children in the UK and their parent- and teacher-rated emotional and behavioral problems. Forty-five children (M age = 75.96 months, SD = 12.98; 51.1% female) who were placed for adoption from public care at a M age of 22.14 months (SD = 14.21) completed a battery of age standardized neurocognitive tests, and adoptive parents and school teachers rated their emotional and behavioral problems. Children had more emotional and behavioral problems than the general population and over a fifth scored low (> 1 SD below the expected range for their age) in 5/6 neurocognitive tasks. Children who scored low on the non-verbal reasoning task were more likely to have more parent- and teacher-rated behavioral problems, and children's performance on the inhibitory control and cognitive flexibility tasks were associated with parent-rated behavioral problems. Children's verbal reasoning scores were positively associated with both parent- and teacher-rated emotional problems. Children who were adopted later in childhood scored significantly lower in non-verbal reasoning. Although longitudinal studies are needed to clarify the nature of neurocognitive functioning as a marker for later mental health problems, our findings underscore the importance of using comprehensive assessments to better recognize adopted children's difficulties and inform appropriate intervention initiatives.

Early childhood deprivation is associated with alterations in adult brain structure despite subsequent environmental enrichment

Millions of children worldwide live in nonfamilial institutions. We studied impact on adult brain structure of a particularly severe but time-limited form of institutional deprivation in early life experienced by children who were subsequently adopted into nurturing families. Institutional deprivation was associated with lower total brain volume in a dose-dependent way. Regionally specific effects were seen in medial prefrontal, inferior frontal, and inferior temporal areas. Deprivation-related alterations in total brain volume were associated with lower intelligence quotient and more attention deficit/hyperactivity disorder symptoms; alterations in temporal volume seemed compensatory, as they were associated with fewer attention deficit/hyperactivity disorder symptoms. We provide evidence that early childhood deprivation is related to alterations in adult brain structure, despite environmental enrichment in intervening years.

Early childhood deprivation is associated with higher rates of neurodevelopmental and mental disorders in adulthood. The impact of childhood deprivation on the adult brain and the extent to which structural changes underpin these effects are currently unknown. To investigate these questions, we utilized MRI data collected from young adults who were exposed to severe deprivation in early childhood in the Romanian orphanages of the Ceaușescu era and then, subsequently adopted by UK families; 67 Romanian adoptees (with between 3 and 41 mo of deprivation) were compared with 21 nondeprived UK adoptees. Romanian adoptees had substantially smaller total brain volumes (TBVs) than nondeprived adoptees (8.6% reduction), and TBV was strongly negatively associated with deprivation duration. This effect persisted after covarying for potential environmental and genetic confounds. In whole-brain analyses, deprived adoptees showed lower right inferior frontal surface area and volume but greater right inferior temporal lobe thickness, surface area, and volume than the nondeprived adoptees. Right medial prefrontal volume and surface area were positively associated with deprivation duration. No deprivation-related effects were observed in limbic regions. Global reductions in TBV statistically mediated the observed relationship between institutionalization and both lower intelligence quotient (IQ) and higher levels of attention deficit/hyperactivity disorder symptoms. The deprivation-related increase in right inferior temporal volume seemed to be compensatory, as it was associated with lower levels of attention deficit/hyperactivity disorder symptoms. We provide compelling evidence that time-limited severe deprivation in the first years of life is related to alterations in adult brain structure, despite extended enrichment in adoptive homes in the intervening years.

Potentially traumatic events in foster youth, and association with DSM-5 trauma- and stressor related symptoms

BACKGROUND

In DSM 5, three disorders are related to trauma and/or maltreatment: Post-traumatic Stress Disorder (PTSD), Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) but how these disorders relate to each other and to traumatic events is unknown.

OBJECTIVE

We examined 1. Prevalence of Potentially Traumatic Events (PTEs) and poly-victimization for youths in foster care. 2. Associations between single/multiple PTEs and PTSD, DSED, and the two symptom-clusters that constitute RAD: Failure to seek/accept comfort (RAD A), and Low social-emotional responsiveness/ emotion dysregulation (RAD B).

PARTICIPANTS, SETTING AND METHODS

Foster youth 11-17 years (N = 303) in Norway completed The Child and Adolescent Trauma Screen. Foster parents completed the RAD and DSED Assessment interview.

RESULTS

Foster youth reported experiencing, on average, 3.44 PTEs each (range 0-15, SD 3.33), and 52.9 % reported PTSD symptoms at or above clinical cut off. The PTE sum score was associated with the latent factors PTSD (r = .66, p < 0.001), RAD cluster B symptoms (Low social-emotional responsiveness / emotion dysregulation, r = .28, p < 0.001) and DSED (r = .11, p = 0.046), but not with RAD cluster A symptoms (Failure to seek/accept comfort).

CONCLUSIONS

These findings raise new questions about the nature, mechanisms and timing of development of RAD and DSED. Maltreatment assessment needs to encompass a wide range of PTEs, and consider poly-victimization.

Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA): A developmental cohort study protocol

BACKGROUND

Low and middle-income countries like India with a large youth population experience a different environment from that of high-income countries. The Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA), based in India, aims to examine environmental influences on genomic variations, neurodevelopmental trajectories and vulnerability to psychopathology, with a focus on externalizing disorders.

METHODS

cVEDA is a longitudinal cohort study, with planned missingness design for yearly follow-up. Participants have been recruited from multi-site tertiary care mental health settings, local communities, schools and colleges. 10,000 individuals between 6 and 23 years of age, of all genders, representing five geographically, ethnically, and socio-culturally distinct regions in India, and exposures to variations in early life adversity (psychosocial, nutritional, toxic exposures, slum-habitats, socio-political conflicts, urban/rural living, mental illness in the family) have been assessed using age-appropriate instruments to capture socio-demographic information, temperament, environmental exposures, parenting, psychiatric morbidity, and neuropsychological functioning. Blood/saliva and urine samples have been collected for genetic, epigenetic and toxicological (heavy metals, volatile organic compounds) studies. Structural (T1, T2, DTI) and functional (resting state fMRI) MRI brain scans have been performed on approximately 15% of the individuals. All data and biological samples are maintained in a databank and biobank, respectively.

DISCUSSION

The cVEDA has established the largest neurodevelopmental database in India, comparable to global datasets, with detailed environmental characterization. This should permit identification of environmental and genetic vulnerabilities to psychopathology within a developmental framework. Neuroimaging and neuropsychological data from this study are already yielding insights on brain growth and maturation patterns.

The psychobiological consequences of child separation at the border: lessons from research on attachment and emotion regulation

In the spring of 2018, the Attorney General of the United States issued a memorandum declaring a "zero tolerance policy" under which all adults entering the United States illegally would be criminally prosecuted, and, if traveling with minor children, forcibly separated from their children. Although the government was ordered to reunite the children with their parents it is still unclear how many children have been or remain separated. Given the high risk of permanent harm to a vulnerable population, and the fact that this risk may continue into the near future, we present a review of what nearly eight decades of scholarly research has taught us about the damaging impact of deprivation and separation from parents. The article briefly reviews the origins of attachment theory as well as empirical studies that examine the psychobiological impact on children who experienced parental deprivation or separation. The paper concludes with recommendations, for future research.

Early family adversity, stability and consistency of institutional care and infant cognitive, language and motor development across the first six months of institutionalization

This study extends research on the effects of institutionalization-by examining the trajectories of cognitive, language and motor development of 64 Portuguese infants and toddlers across the first six months of institutionalization, while determining whether pre-institutional adversities and the stability and consistency of institutional care predict children's development. At time of enrollment, 23.4%, 32.8% and 31.3% of the children were moderately to severely delayed, respectively, in their cognitive, linguistic and motor functioning. Developmental problems persisted after six months of institutionalization. The accumulation of early pre-institutional adversities predicted cognitive and motor limitations at admission to the institutions, but not variation in subsequent development. The stability and consistency of institutional care also failed to predict developmental growth and change. Children who had never lived with their families of origin showed a better language development at enrollment than their counterparts who had lived with their families of origin before institutionalization. Such advantage was followed by a deceleration in language growth after six months of institutional placement. Results are discussed in terms of short- vs. longer-term effects of institutionalization.

Midlife reversibility of early-established biobehavioral risk factors: A research agenda

Epidemiological evidence links exposure to early life adversities-such as childhood maltreatment-with impaired health and well-being in adulthood. Since these effects are usually unrecognized or untreated in childhood, preventive and remediating interventions in adults are needed. Our focus on adulthood prompted three major questions. First, does our increased understanding of mechanisms accounting for the long-term effects of early life adversities help delineate underlying dimensions that underscore key similarities and differences among these adversities? Second, can adults accurately report on adversities they experienced in childhood? Third, can we identify malleable risk processes in adulthood that might be targets for preventive intervention? Supported by the National Institute on Aging, the U.K. Economic and Social and the Biotechnology and Biological Sciences Research Councils, a network of researchers in human and animal development addressed these questions through meetings and literature review. A small number of dimensions may adequately distinguish among a range of co-occurring childhood adversities. Widely used adult ascertainments of childhood adversity are poorly related to prospective ascertainment. Strategies for preventive interventions should be aimed both at adults who were actually exposed to adversity as well as those who recall adversity, but the targeted risk processes may be different. Now is an opportune time to support research on adult interventions based on unfolding research on critical periods of sensitivity to adversity in fetal and child development, on improved understanding of risk mechanisms that may persist across the life span, and on new insights on enhancing neuroplasticity in adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Late-adopted children grown up: a long-term longitudinal study on attachment patterns of adolescent adoptees and their adoptive mothers

This paper reports on a long-term follow-up of a longitudinal study conducted in Italy that assessed attachment patterns of late-adopted children (placed between 4 and 8 years old) and their adoptive mothers, in three phases: T1, at placement; T2, in childhood (7-8 months after adoption); and T3, in adolescence (current study). The following hypotheses were tested: 1) children' IWMs will shift from insecurity towards security in a long-term follow-up; and 2) there will be a significant association between adoptees' and adoptive mothers' IWMs in adolescence. Participants were 22 late-adopted adolescents (aged 11-16) and their adoptive mothers, all assessed in previous phases. Participants completed several measures of attachment, including the Separation-Reunion Procedure (T1, T2), Manchester Child Attachment Story Task (T2), Friends and Family Interview (T3), and Adult Attachment Interview (T1, T3). Late-adopted adolescents showed both an increase in attachment security and a decrease in disorganized attachment from childhood to adolescence. Adoptive mothers' (T3) secure states of mind were associated significantly to their adopted children attachment security in adolescence. These findings reinforce the importance of taking attachment into account for adoptive families from the beginning of adoption.

Neurocognitive Development of Motivated Behavior: Dynamic Changes across Childhood and Adolescence

The ability to anticipate and respond appropriately to the challenges and opportunities present in our environments is critical for adaptive behavior. Recent methodological innovations have led to substantial advances in our understanding of the neurocircuitry supporting such motivated behavior in adulthood. However, the neural circuits and cognitive processes that enable threat- and reward-motivated behavior undergo substantive changes over the course of development, and these changes are less well understood. In this article, we highlight recent research in human and animal models demonstrating how developmental changes in prefrontal-subcortical neural circuits give rise to corresponding changes in the processing of threats and rewards from infancy to adulthood. We discuss how these developmental trajectories are altered by experiential factors, such as early-life stress, and highlight the relevance of this research for understanding the developmental onset and treatment of psychiatric disorders characterized by dysregulation of motivated behavior.

[Personality Assessment as Contribution to Diagnostic Differentiation Between ADHD and RAD in Middle Childhood]

Personality Assessment as Contribution to Diagnostic Differentiation Between ADHD and RAD in Middle Childhood Early and prolonged social and emotional deprivation can result in symptoms of both ADHD and attachment disorder (RAD). The present study compares children between 7 and 13 years of age diagnosed with either ADHD or RAD, regarding their disorder specific behavior by using the Conners Rating Scale, a RAD screening scale, the overall psychopathology in the CASCAP-D, and the children's personality using the California Child-Q-sort (CCQ). The RAD group showed an increased overall psychopathology score and both increased ADHD and RAD symptomatology. In addition, they also were characterized as lower in self-regulatory personality characteristics (e. g. ego-resiliency). The results suggest that children with a RAD diagnosis do not show two comorbid disorders (RAD plus ADHD) but are characterized by an even more intense deficit of self-regulation in social and emotional contexts, compared to the children of the pure ADHD group. This should be considered in diagnosis and treatment.

Maternal behavior predicts neural underpinnings of inhibitory control in preschoolers

Separate lines of research have revealed that the rapid development of inhibitory control in the preschool period is closely tied to normative brain development and influenced by early mother-child interactions. One potential theory is that maternal behavior in the context of early interactions influences the neural underpinnings of inhibitory control in development, with implications for child behavior. The purpose of this paper was to examine whether maternal emotional support, measured during a mother-child problem-solving game, predicted child neural responses (frontal-central N2 event-related potential) and behavioral performance (discrimination index, d') in a go/no-go task of inhibitory control in a large, diverse sample of mother-child dyads (N = 276) observed in children's last year of preschool (mean age = 56 months). Results of a structural equation model revealed significant direct effects from maternal emotional support to child right hemisphere frontal-central N2 responses to no-go (inhibitory control) trials; greater observed emotional support predicted larger N2 responses. Larger right hemisphere N2 responses to no-go trials were also associated with better overall observed task performance (d'). A test of indirect effects from maternal emotional support to child observed performance via right hemisphere N2 responses was significant, suggesting that underlying neurophysiology is one mechanism through which maternal emotional support is associated with a child's rapidly developing inhibitory control behavior in the preschool period. This work joins a growing literature demonstrating that caregiver behavior within a "normative" range is an important environmental factor contributing to the development of neural processes supporting child functioning.

Kinds of individuals defined by patterns of variables

This paper argues that investigators should consider replacing the popular practice of comparing individuals varying in gender, social class, and/or ethnicity on one or more continuous measures with a search for kinds of individuals defined by patterns of properties that include not only their values on outcome measures but also their gender, social class, and ethnicity. Investigators who believe that a particular predictor contributes to an outcome independent of the gender, class, or ethnicity of the participants often implement statistical procedures that promise to remove the contributions of the above categories. These analyses lead to misleading conclusions when the controlled category is correlated with the dependent measures. The final sections summarize the properties of genders, classes, and ethnic groups that make distinctive contributions to many psychological outcomes. The paper ends by noting that a society's ethical beliefs constitute a defensible basis for ignoring the biological properties associated with these categories in order to allow members of these groups access to whatever educational or occupational goals they desire.

Examining the Relationship Between Anxiogenic Parenting Practices and Cognitive Flexibility in Youth

Cognitive flexibility (CF), a subdomain of executive functioning (EF), involves abilities such as set shifting and reversal learning. Some variability in CF is normative across youth due to the gradual refinement of broader EF along with the prefrontal cortex. Prior research has suggested that a supportive parenting environment contributes to strong EF, whereas harsh/controlling parenting is associated with deficits. The current investigation explores whether certain parenting practices (e.g., parental accommodation, over-involvement, modeling) are associated with such deficits. Anxiogenic parenting and CF were assessed in 112 youth aged 9 to 17 years, with results demonstrating that parenting practices were not predictive of CF in these youth. Age accounted for the majority of differences in set shifting performance, potentially emphasizing the influence of parenting at different stages of development. Accordingly, future research is necessary to determine the potential impact of anxiogenic parenting at specific points in the development of CF.

Vinculação e problemas de comportamento avaliados por crianças e pais

A teoria da vinculação, salienta a importância das relações precoces na estruturação do self, e conceção dos outros. O presente estudo analisa relações entre vinculação aos pais e problemas de comportamento reportados por 258 crianças (9-12 anos) e seus pais. O Inventário de Vinculação aos Pais e Pares e o Questionário de Forças e Dificuldades foram utilizados. Dimensões seguras da vinculação – “Comunicação-proximidade” e “Aceitação mútua-compreensão”) correlacionam negativamente com problemas internalizados, e “Afastamento-rejeição” positivamente com problemas in/externalizados. Os rapazes reportam mais problemas exteriorizados, e a hiperatividade é o comportamento mais reportado por crianças e seus pais.

Early childhood parenting and child impulsivity as precursors to aggression, substance use, and risky sexual behavior in adolescence and early adulthood

The current study utilized a longitudinal design to explore the effect of early child impulsivity and rejecting parenting on the development of problematic behaviors in adolescence and early adulthood. Using a low-income sample of 310 mothers and their sons, we examined the direct and interactive effects of child impulsivity and rejecting parenting at age 2 on aggression and substance use at ages 12, 15, and 22, as well as risky sexual behavior at ages 15 and 22. Results revealed that rejecting parenting at age 2 predicted greater aggression at age 12 and risky sexual behavior at ages 15 and 22. Early impulsivity had few direct effects on later outcomes, with the exception of greater substance use at age 22. Instead, impulsivity emerged as a significant moderator in the link between rejecting parenting and aggression at all three ages and substance use at age 15. Specifically, early rejecting parenting predicted greater aggression and substance use only for children high in impulsivity. Findings highlight the potential for early child and parenting risk factors to have long-term implications for adjustment, with the combination of high impulsivity and rejecting parenting being particularly deleterious for problems of aggression throughout adolescence and into early adulthood.

Commentary: Extraordinary environments, extreme neuroplasticity and mental disorder - reflections on pathways from adversity to mental disorder prompted by McCrory, Gerin, and Viding (2017)

Neuroplasticity, the brain's capacity to be shaped in response to environmental experience, has been claimed to resemble a double-edged sword - potentiating growth and healing when individuals are exposed to normative, benign or therapeutic environments on the one hand, mediating mental disorder development in those exposed to adversity, on the other. However, questions about the scope and limits of neuroplasticity and, especially, its clinical significance, remain unanswered.

False Belief Performance of Children Adopted Internationally

PURPOSE

The purpose of this study was to explore relationships among adoption, individual, and family variables on false belief performance of children adopted internationally (CAI).

METHOD

Using a quasiexperimental design, thirty-five 4-year-old children adopted from Asian and Eastern European countries before age 2 years were compared with a U.S. group of 33 nonadopted 4-year-old children on a standardized English-language measure, 3 false belief tasks, and a go/no-go inhibition measure.

RESULTS

The adopted group differed significantly from the U.S. nonadopted group in expressive language and false belief performance. For the adopted group, inhibition measures were significantly correlated with core language scores. Core language scores and number of older siblings predicted false belief performance.

CONCLUSIONS

Similar to children who are not adopted, language competence and living with older siblings positively influenced social understanding in CAI. Because CAI experience interrupted language acquisition and live with fewer older siblings, they are at risk of having weaker language competence and social understanding in their adopted language. When working with CAI, practitioners should assess social communication, language competence, and inhibition skills. They should assist adoptive families in providing socially mentored opportunities for their children to observe and interact with older children.

Biological embedding: evaluation and analysis of an emerging concept for nursing scholarship

AIM

The purpose of this paper was to report the analysis of the concept of biological embedding.

BACKGROUND

Research that incorporates a life course perspective is becoming increasingly prominent in the health sciences. Biological embedding is a central concept in life course theory and may be important for nursing theories to enhance our understanding of health states in individuals and populations. Before the concept of biological embedding can be used in nursing theory and research, an analysis of the concept is required to advance it towards full maturity.

DESIGN

Concept analysis.

DATA SOURCES

PubMed, CINAHL and PsycINFO were searched for publications using the term 'biological embedding' or 'biological programming' and published through 2015.

METHODS

An evaluation of the concept was first conducted to determine the concept's level of maturity and was followed by a concept comparison, using the methods for concept evaluation and comparison described by Morse.

RESULTS

A consistent definition of biological embedding - the process by which early life experience alters biological processes to affect adult health outcomes - was found throughout the literature. The concept has been used in several theories that describe the mechanisms through which biological embedding might occur and highlight its role in the development of health trajectories. Biological embedding is a partially mature concept, requiring concept comparison with an overlapping concept - biological programming - to more clearly establish the boundaries of biological embedding.

CONCLUSIONS

Biological embedding has significant potential for theory development and application in multiple academic disciplines, including nursing.

Editorial: The effects of early trauma and deprivation on human development - from measuring cumulative risk to characterizing specific mechanisms

Science is not a linear process of accumulating knowledge. To the contrary, progress in understanding is most likely to occur, especially in less 'mature' disciplines, when healthy debate between opposing points of view create a dialectic in which thesis and antithesis force a new synthesis. In developmental psychopathology, such tension between opposing schools of thought continue to play a vital role in driving discovery across a wide range of topics.

Early severe institutional deprivation is associated with a persistent variant of adult attention-deficit/hyperactivity disorder: clinical presentation, developmental continuities and life circumstances in the English and Romanian Adoptees study

BACKGROUND

Early-life institutional deprivation is associated with attention-deficit/hyperactivity disorder (ADHD) later in childhood and adolescence. In this article, we examine, for the first time, the persistence of deprivation-related ADHD into young adulthood in a sample of individuals adopted as young children by UK families after periods in extremely depriving Romanian orphanages.

METHODS

We estimated rates of ADHD at age 15 years and in young adulthood (ages 22-25 years) in individuals at low (LoDep; nondeprived UK adoptees and Romanian adoptees with less than 6-month institutional exposure) and high deprivation-related risk (HiDep; Romanian adoptees with more than 6-month exposure). Estimates were based on parent report using DSM-5 childhood symptom and impairment criteria. At age 15, data were available for 108 LoDep and 86 HiDep cases, while in young adulthood, the numbers were 83 and 60, respectively. Data on education and employment status, IQ, co-occurring symptoms of young adult disinhibited social engagement (DSE), autism spectrum disorder (ASD), cognitive impairment, conduct disorder (CD), callous-unemotional (CU) traits, anxiety, depression and quality of life (QoL) were also collected.

RESULTS

ADHD rates in the LoDep group were similar to the general population in adolescence (5.6%) and adulthood (3.8%). HiDep individuals were, respectively, nearly four (19%) and over seven (29.3%) times more likely to meet criteria, than LoDep. Nine 'onset' young adult cases emerged, but these had a prior childhood history of elevated ADHD behaviours at ages 6, 11 and 15 years. Young adult ADHD was equally common in males and females, was predominantly inattentive in presentation and co-occurred with high levels of ASD, DSE and CU features. ADHD was associated with high unemployment and low educational attainment.

CONCLUSION

We provide the first evidence of a strong persistence into adulthood of a distinctively complex and impairing deprivation-related variant of ADHD. Our results confirm the powerful association of early experience with later development in a way that suggests a role for deep-seated alterations to brain structure and function.

Empirical tests of natural selection-based evolutionary accounts of ADHD: a systematic review

OBJECTIVE

ADHD is a prevalent and highly heritable mental disorder associated with significant impairment, morbidity and increased rates of mortality. This combination of high prevalence and high morbidity/mortality seen in ADHD and other mental disorders presents a challenge to natural selection-based models of human evolution. Several hypotheses have been proposed in an attempt to resolve this apparent paradox. The aim of this study was to review the evidence for these hypotheses.

METHODS

We conducted a systematic review of the literature on empirical investigations of natural selection-based evolutionary accounts for ADHD in adherence with the PRISMA guideline. The PubMed, Embase, and PsycINFO databases were screened for relevant publications, by combining search terms covering evolution/selection with search terms covering ADHD.

RESULTS

The search identified 790 records. Of these, 15 full-text articles were assessed for eligibility, and three were included in the review. Two of these reported on the evolution of the seven-repeat allele of the ADHD-associated dopamine receptor D4 gene, and one reported on the results of a simulation study of the effect of suggested ADHD-traits on group survival. The authors of the three studies interpreted their findings as favouring the notion that ADHD-traits may have been associated with increased fitness during human evolution. However, we argue that none of the three studies really tap into the core symptoms of ADHD, and that their conclusions therefore lack validity for the disorder.

CONCLUSIONS

This review indicates that the natural selection-based accounts of ADHD have not been subjected to empirical test and therefore remain hypothetical.

A review of 25 years of research in bidirectionality in parent–child relationships

The concept of bidirectionality represents a process of mutual influence between parent and child, whereby each influences the other as well as the dyadic relationship. Despite the widespread acceptance of bidirectional models of influence, there is still a lack of integration of such models in current research designs. Research on bidirectionality could be strengthened through the adoption of advanced methodologies, including behavioral-genetic research designs and advanced structural equation modeling. The aim of this empirical review is to further advance the study of bidirectionality by evaluating the evidence from 25 years of bidirectionality research in infancy and early childhood. The review indicates significant advancements in the use of methods that address the ecological validity of bidirectional effects, as well as areas that continue to rely on correlational designs to detect bidirectional effects. We describe analytic approaches that may improve the specificity of bidirectionality evidence and highlight gene–environment interaction designs as a promising area for future bidirectionality research.

Longitudinal Associations Between the Quality of Mother-Infant Interactions and Brain Development Across Infancy

The aim of this study was to investigate if normative variations in parenting relate to brain development among typically developing children. A sample of 352 mother-infant dyads came to the laboratory when infants were 5, 10, and 24 months of age (final N = 215). At each visit, child resting electroencephalography (EEG) was recorded. Mother-infant interactions were videotaped at the 5-month visit. The results indicated that higher quality maternal behavior during mother-infant interactions predicted higher frontal resting EEG power at 10 and 24 months, as well as increases in power between 5 and 10 months, and between 10 and 24 months. These findings provide rare support for the hypothesis that normative variation in parenting quality may contribute to brain development among typically developing infants.

Post-institutionalized Chinese and Eastern European children: Heterogeneity in the development of emotion understanding

Post-institutionalized Chinese and Eastern European children participated in two emotion understanding tasks. In one task, children selected facial expressions corresponding to four emotion labels (happy, sad, angry, scared). The second task required children to match facial expressions to stories describing situations for these emotions. While both post-institutionalized groups scored lower than the never-institutionalized children, those from China performed better than those from Eastern Europe. Post-institutionalized children's performance was predicted by their age at adoption.

Health status, cognitive and motor development of young children adopted from China, East Asia, and Russia across the first 6 months after adoption

We compared health status, anthropometric and psychological development of 123 children adopted before 18 months of age from China, East Asia (Vietnam, Taiwan, Thailand, South Korea, Cambodia), and Eastern Europe (mostly Russia). Data were collected close to the time of arrival, and 3 and 6 months later. Anthropometric measures included weight, height, and head circumference percentiles, and weight/height and height/age ratios (indices of acute and chronic malnutrition, respectively). We assessed cognitive (MDI) and motor (PDI) developments with the Bayley Scales of Infant Development (Bayley, 1993). At time of arrival, children presented physical, cognitive, and motor delays, as well as health problems. Growth parameters improved with time, but differently among the groups. East Asian children, in a better physical state at time of arrival, changed less than the others did across time. Children adopted from Russia globally had lower MDI than the others, while children adopted from East Asia had the highest PDI. Hierarchical linear modelling indicated that initial MDI was related to height/age ratio (index of chronic malnutrition), while its change over time was related to age at time of arrival. PDI was also related to height/age ratio, as well as to presence/absence of neurological signs at time of arrival. Infants with a higher risk index had lower MDI and PDI initial scores.

Predicting ADHD by Assessment of Rutter's Indicators of Adversity in Infancy

Background

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder with early onset. ADHD is associated with significant morbidity and mortality, partly due to delayed diagnosis. Identification of children at high risk for developing ADHD could lead to earlier diagnosis and potentially change the negative trajectory of the illness for the better. Since early psychosocial adversity is considered to be a likely etiological risk factor for ADHD, markers of this construct may be useful for early identification of children at high risk. Therefore, we sought to investigate whether Rutter’s indicators of adversity (low social class, severe marital discord, large family size, paternal criminality, maternal mental disorder, and placement in out-of-home care) assessed in infancy could serve as early predictors for the development of ADHD.

Methods and Findings

Using data from the Danish nationwide population-based registers, we established a cohort consisting of all 994,407 children born in Denmark between January 1^st 1993 and December 31^st 2011 and extracted dichotomous values for the six Rutter’s indicators of adversity at age 0–12 months (infancy) for each cohort member. The cohort members were followed from their second birthday and the association between the sum of Rutter’s indicators of adversity (RIA-score) in infancy and subsequent development of ADHD was estimated by means of Cox regression. Also, the number needed to screen (NNS) to detect one case of ADHD based on the RIA-scores in infancy was calculated. During follow-up (9.6 million person-years), 15,857 males and 5,663 females from the cohort developed ADHD. For both males and females, there was a marked dose-response relationship between RIA-scores assessed in infancy and the risk for developing ADHD. The hazard ratios for ADHD were 11.0 (95%CI: 8.2–14.7) and 11.4 (95%CI: 7.1–18.3) respectively, for males and females with RIA-scores of 5–6, compared to males and females with RIA-scores of 0. Among males with RIA-scores of 5–6, 37.6% (95%CI: 27.0–50.7) had been diagnosed with ADHD prior to the age of 20, corresponding to a NNS of 3.0 (95%CI: 2.2–4.0).

Conclusions

Rutter’s indicators of adversity assessed in infancy strongly predicted ADHD. This knowledge may be important for early identification of ADHD.

Do internationally adopted children in the Netherlands use more medication than their non-adopted peers?

Empirical evidence has shown that international adoptees present physical growth delays, precocious puberty, behavioral problems, and mental health referrals more often than non-adoptees. We hypothesized that the higher prevalence of (mental) health problems in adoptees is accompanied by elevated consumption of prescription drugs, including antidepressants, attention deficit hyperactivity disorder (ADHD) medication, and medication for growth inhibition/stimulation. In an archival, population-based Dutch cohort study, data on medication use were available from the Health Care Insurance Board by Statistics Netherlands from 2006 to 2011. The Dutch population born between 1994 and 2005 and alive during the period of measurement was included (2,360,450 including 10,602 international adoptees, of which 4447 from China). Their mean age was 6.5 years at start (range 1-12 years) and 11.5 years at the end of the measurement period (range 6-17 years). Chinese female adoptees used less medication for precocious puberty (as treatment for precocious puberty; odds ratio (OR) = 0.57, effect size Cohen's d = -0.31) and contraception (OR = 0.65, d = -0.24) than non-adoptees. For both males and females, non-Chinese adoptees used more medication for ADHD than non-adoptees (males: OR = 1.22, females: OR = 1.32), but the effect was small (males: d = 0.11, females: d = 0.15).

CONCLUSIONS

Adoptees in the Netherlands generally do not use more medication than their non-adopted peers.

WHAT IS KNOWN

• Meta-analytical evidence shows that international adoptees present physical growth delays and mental health referrals more often than non-adopted controls. • With the exception of one Swedish study on ADHD medication, there is no other systematic research on medication use of international adoptees. What is New: • All differences in medication use between international adoptees in the Netherlands and non-adopted controls were below the threshold of a small effect with the exception of medication for precocious puberty, but this effect was in the opposite direction with female adoptees using less medication for precocious puberty than non-adoptees. • International adoptees in the Netherlands do not use more medication despite experiences of preadoption adversity and higher rates of mental health referrals during childhood and adolescence.

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

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