Language acquisition with limited input: Romanian institution and foster care

Receptive and expressive vocabulary performance in 2- to 5-year-olds in care: The role of different care types and temperament

The detrimental role of institutionalization in children's development has prompted the introduction of alternative care types designed to offer more personalized care. The current study aimed to test whether children in alternative care types (care villages, care homes, and foster care) performed better on vocabulary than those in institutions. The role of temperament, specifically perceptual sensitivity and frustration, and the interaction between temperament and care types on vocabulary performance were also explored. The study involved 285 2- to 5-year-old children from different care types, and they were assessed through receptive and expressive vocabulary tests and temperament scales. The results of the linear mixed model revealed that children in alternative care types exhibited significantly higher vocabulary scores compared with those in institutions. Moreover, perceptual sensitivity showed a positive association with receptive and expressive vocabulary skills and seemed to act as a protective factor by mitigating the lower vocabulary scores in institutions. Frustration moderated vocabulary outcomes differently for children in institutions and foster care, aligning with the diathesis-stress model and vantage sensitivity theory, respectively. The findings emphasize the positive role of alternative care types in vocabulary performance and the importance of children's temperamental traits in this process.

Gender differences in the associations between childhood adversity and psychopathology in the general population

PURPOSE

To explore gender differences of the associations between childhood adversity (CA) subtypes and psychiatric symptoms in the general population.

METHODS

Data of 791 participants were retrieved from a general population twin cohort. The Symptom Checklist-90 Revised (SCL-90) and the Childhood Trauma Questionnaire were used to assess overall psychopathology with nine symptom domains scores and total CA with exposure to five CA subtypes, respectively. The associations between CA and psychopathology were analyzed in men and women separately and were subsequently compared.

RESULTS

Total CA was associated with total SCL-90 and all symptom domains without significant gender differences. However, the analyses of CA subtypes showed that the association between emotional abuse and total SCL-90 was stronger in women compared to men [χ2(1) = 4.10, P = 0.043]. Sexual abuse was significantly associated with total SCL-90 in women, but emotional neglect and physical neglect were associated with total SCL-90 in men. Exploratory analyses of CA subtypes and SCL-90 subdomains confirmed the pattern of gender-specific associations. In women, emotional abuse was associated with all symptom domains, and sexual abuse was associated with all except phobic anxiety and interpersonal sensitivity. In men, emotional neglect was associated with depression, and physical neglect was associated with phobic anxiety, anxiety, interpersonal sensitivity, obsessive-compulsive, paranoid ideation, and hostility subdomains.

CONCLUSION

CA is a trans-syndromal risk factor regardless of gender. However, differential associations between CA subtypes and symptom manifestation might exist. Abuse might be particularly associated with psychopathology in women, whereas neglect might be associated with psychopathology in men.

The effects of early life adversity on children's mental health and cognitive functioning

Emerging evidence suggests that partially distinct mechanisms may underlie the association between different dimensions of early life adversity (ELA) and psychopathology in children and adolescents. While there is minimal evidence that different types of ELA are associated with specific psychopathology outcomes, there are partially unique cognitive and socioemotional consequences of specific dimensions of ELA that increase transdiagnostic risk of mental health problems across the internalizing and externalizing spectra. The current review provides an overview of recent findings examining the cognitive (e.g., language, executive function), socioemotional (e.g., attention bias, emotion regulation), and mental health correlates of ELA along the dimensions of threat/harshness, deprivation, and unpredictability. We underscore similarities and differences in the mechanisms connecting different dimensions of ELA to particular mental health outcomes, and identify gaps and future directions that may help to clarify inconsistencies in the literature. This review focuses on childhood and adolescence, periods of exquisite neurobiological change and sensitivity to the environment. The utility of dimensional models of ELA in better understanding the mechanistic pathways towards the expression of psychopathology is discussed, with the review supporting the value of such models in better understanding the developmental sequelae associated with ELA. Integration of dimensional models of ELA with existing models focused on psychiatric classification and biobehavioral mechanisms may advance our understanding of the etiology, phenomenology, and treatment of mental health difficulties in children and youth.

Time after a peak-pesticide use period and neurobehavior among ecuadorian children and adolescents: The ESPINA study

BACKGROUND

Limited evidence exists regarding transient neurobehavioral alterations associated with episodic pesticide exposures or agricultural pesticide spray periods. We previously observed that children examined soon after a pesticide spray period (the Mother's Day flower harvest [MDH]) had lower neurobehavioral performance than children examined later. The present study builds on our previous work by incorporating longitudinal analyses from childhood through adolescence.

METHODS

We examined participants in agricultural communities in Ecuador (ESPINA study) during three periods: July-August 2008 (N = 313, 4-9-year-olds); April 2016 (N = 330, 11-17-year-olds); July-October 2016 (N = 535, 11-17-year-olds). Participants were examined primarily during a period of low floricultural production. Neurobehavior was assessed using the NEPSY-II (domains: Attention/Inhibitory Control, Language, Memory/Learning, Visuospatial Processing, and Social Perception). Linear regression and generalized linear mixed models were used to examine cross-sectional and longitudinal associations between examination date (days) after the MDH and neurobehavioral outcomes, adjusting for demographic, anthropometric, and socio-economic variables.

RESULTS

Participants were examined between 63 and 171 days after the MDH. Mean neurobehavioral domain scores ranged from 1.0 to 17.0 (SD_range = 2.1-3.1) in 2008 and 1.0 to 15.5 (SD_range = 2.0-2.3) in 2016. In cross-sectional analyses (2016 only; N = 523), we found significant or borderline positive associations between time after the MDH and Attention/Inhibitory Control (difference/10 days [β] = 0.22 points [95% CI = 0.03, 0.41]) and Language (β = 0.16 points [95% CI = -0.03, 0.34]). We also observed positive, longitudinal associations (2008-2016) with Attention/Inhibitory Control (β = 0.19 points [95% CI = 0.04, 0.34]) through 112 days after the harvest and Visuospatial Processing (β = 3.56, β-quadratic = -0.19 [95% CI: -0.29, -0.09]) through 92 days.

CONCLUSIONS

Children examined sooner after the harvest had lower neurobehavioral performance compared to children examined later, suggesting that peak pesticide spray seasons may transiently affect neurobehavior followed by recovery during low pesticide-use periods. Reduction of pesticide exposure potential for children during peak pesticide-use periods is advised.

The effects of maternal input on language in the absence of genetic confounds: Vocabulary development in internationally adopted children

Previous studies have found correlations between parent input and child language outcomes, providing prima facie evidence for a causal relation. However, this could also reflect the effects of shared genes. The present study removed this genetic confound by measuring English vocabulary growth in 29 preschool-aged children (21 girls) aged 31-73 months and 17 infants (all girls) aged 15-32 months adopted from China and Eastern Europe and comparing it to speech produced by their adoptive mothers. Vocabulary growth in both groups was correlated with maternal input features; in infants with mean-length of maternal utterance, and in preschoolers with both mean-length of utterance and lexical diversity. Thus, input effects on language outcomes persist even in the absence of genetic confounds.

Oral and Written Language Abilities of School-Age Internationally Adopted Children from Eastern Europe

PURPOSE

Children adopted from Eastern Europe were assessed at ages 6 to 7 years and results were compared to the same children when they were 8 years. Patterns of relative strengths and weaknesses in language, verbal memory and literacy were analyzed. Variables that predicted reading and writing were determined.

METHOD

Children adopted from Eastern Europe between 1;0 and 4;11 years of age were assessed at ages 6 to 7 years and age 8 years on a variety of tests that measured language, verbal memory and literacy. Results were compared across ages, and language, verbal memory and literacy domains.

RESULTS

Group means for all measures fell within the average range at both ages. The children's scores were not significantly different from test norms except for measures of rapid naming and number repetition. However, a larger than expected percentage of children scored -1SD below the mean on decontextualized measures of verbal working memory and reading fluency. At age 8 years 24% of children received speech language therapy services and 26% had repeated a grade level. Vocabulary, expressive syntax, verbal short-term memory and writing were areas of relative strength. Higher level vocabulary knowledge was strongly correlated with all literacy measures.

CONCLUSION

As a group, Eastern European adoptees scored average on measures of language and literacy at 6 or 7 years and again at age 8 years. However, 26% of the children had repeated a grade and 24% were still receiving speech and language services. Vocabulary was an area of strength reflecting the children's enriched adopted home environments. In-depth knowledge of vocabulary was the best predictor of reading and writing. Some aspects of working memory were a strength but others were not. Rapid naming was also a weakness.

Early institutionalized care disrupts the development of emotion processing in prosody

Millions of children worldwide are raised in institutionalized settings. Unfortunately, institutionalized rearing is often characterized by psychosocial deprivation, leading to difficulties in numerous social, emotional, physical, and cognitive skills. One such skill is the ability to recognize emotional facial expressions. Children with a history of institutional rearing tend to be worse at recognizing emotions in facial expressions than their peers, and this deficit likely affects social interactions. However, emotional information is also conveyed vocally, and neither prosodic information processing nor the cross-modal integration of facial and prosodic emotional expressions have been investigated in these children to date. We recorded electroencephalograms (EEG) while 47 children under institutionalized care (IC) (n = 24) or biological family care (BFC) (n = 23) viewed angry, happy, or neutral facial expressions while listening to pseudowords with angry, happy, or neutral prosody. The results indicate that 20- to 40-month-olds living in IC have event-related potentials (ERPs) over midfrontal brain regions that are less sensitive to incongruent facial and prosodic emotions relative to children under BFC, and that their brain responses to prosody are less lateralized. Children under IC also showed midfrontal ERP differences in processing of angry prosody, indicating that institutionalized rearing may specifically affect the processing of anger.

Auditory Mismatch Negativity Response in Institutionalized Children

The attunement of speech perception/discrimination to the properties of one’s native language is a crucial step in speech and language development at early ages. Studying these processes in young children with a history of institutionalization is of great interest, as being raised in institutional care (IC) may lead to lags in language development. The sample consisted of 82 children, split into two age groups. The younger age group (<12 months) included 17 children from the IC and 17 children from the biological-family-care (BFC) group. The older group (>12 months) consisted of 23 children from the IC group, and 25 children from the BFC group. A double-oddball paradigm with three consonant-vowel syllables was used, utilizing native (Russian) and foreign (Hindi) languages. A Mismatch Negativity (MMN) component was elicited within a 125–225 ms time window in the frontal-central electrode. Findings demonstrate the absence of MMN effect in the younger age group, regardless of the living environment. Children in the older group are sensitive to native deviants and do not differentiate foreign language contrasts. No significant differences were observed between the IC and BFC groups for children older than 12 months, indicating that children in the IC have typical phonological processing. The results show that the MMN effect is not registered in Russian speaking children before the age of 12 months, regardless of their living environment. At 20 months of age, institutionally reared children show no evidence of delays in phonetic development despite a limited experience of language.

How Young Children Learn Language and Speech

Pediatric clinicians are on the front line for prevention of language and speech disorders. This review uses prevailing theories and recent data to justify strategies for prevention, screening and detection, diagnosis, and treatment of language and speech disorders. Primary prevention rests on theories that language learning is an interaction between the child's learning capacities and the language environment. Language learning occurs in a social context with active child engagement. Theories support parent education and public programs that increase children's exposure to child-directed speech. Early detection of delays requires knowledge of language milestones and recognition of high-risk indicators for disorders. Male sex, bilingual environments, birth order, and chronic otitis media are not adequate explanations for significant delays in language or speech. Current guidelines recommend both general and autism-specific screening. Environmental and genetic factors contribute to primary language and speech disorders. Secondary and tertiary prevention requires early identification of children with language and speech disorders. Disorders may be found in association with chromosomal, genetic, neurologic, and other health conditions. Systematic reviews find that speech-language therapy, alone or in conjunction with other developmental services, is effective for many disorders. Speech-language interventions alter the environment and stimulate children's targeted responding to improve their skills.

How Early Experience Shapes Human Development: The Case of Psychosocial Deprivation

Experience plays an essential role in building brain architecture after birth. The question we address in this paper is what happens to brain and behavior when a young child is deprived of key experiences during critical periods of brain development. We focus in particular on the consequences of institutional rearing, with implication for the tens of millions of children around the world who from an early age experience profound psychosocial deprivation. Evidence is clear that deprivation can lead to a host of both short- and long-term consequences, including perturbations in brain structure and function, changes at cellular and molecular levels, and a plethora of psychological and behavioral impairments.

Language Outcomes in Adults with a History of Institutionalization: Behavioral and Neurophysiological Characterization

Impoverished early care environments are associated with developmental deficits in children raised in institutional settings. Despite the accumulation of evidence regarding deficits in general cognitive functioning in this population, less is known about the impact of institutionalization on language development at the level of brain and behavior. We examined language outcomes in young adults and adolescents raised in institutions (n = 23) as compared to their socioeconomic status and age peers raised in biological families (n = 24) using a behavioral language assessment and linguistic event-related potentials (ERPs). Controlling for intelligence, adults with a history of institutionalization demonstrated deficits in lexical and grammatical development and spelling. Analyses of ERP data revealed significant group differences in the dynamic processing of linguistic stimuli. Adults with a history of institutionalization displayed reduced neural sensitivity to violations of word expectancy, leading to reduced condition effects for temporo-spatial factors that tentatively corresponded to the N200, P300/N400, and phonological mismatch negativity. The results suggest that language is a vulnerable domain in adults with a history of institutionalization, the deficits in which are not explained by general developmental delays, and point to the pivotal role of early linguistic environment in the development of the neural networks involved in language processing.

'She didn't have a word of English; we didn't have a word of Vietnamese': Exploring parent experiences of communication with toddlers who were adopted internationally

The purpose of this study was to explore in detail parents' experiences of communicating with toddlers who were adopted internationally. Often, there is a mismatch between parents and children in terms of language, particularly in the early post-adoption period. There is a gap in the literature regarding parent experiences of this phase of their lives. Changing patterns in international adoption have led to an increase in adoptions of toddlers and older children. Due to institutional care, these toddlers and older children often lack exposure to their native language which may lead to language delay. When they are brought home, they are immersed in English. As well beginning to acquire English, these children are also forming an attachment with their parents. While research has investigated speech and language skills in this population, there is a lack of literature exploring the experiences of parents regarding communicating with toddlers who are adopted internationally in the early months following adoption. This is a qualitative study where interviews and thematic analysis were used to explore the experiences of 12 parents of 12 toddlers who were adopted internationally. Three main themes: 'Getting ready', 'Support', and 'Challenges' emerged from the data. The results highlight the ways in which adoptive parents facilitated communication with their toddlers, supporting their acquisition of English. The results also reveal gaps in service provision for this population. Results also illustrate the proactive way in which parents dealt with challenges, even in the presence of limited support services. Gaps in service provision where intense focus pre-adoption was followed by a lack of support post-adoption were identified by parents. The dual needs of developing attachment and common language development strategies were also described by parents. The study demonstrates the need for pre- and post-adoptive speech and language services for this client group. It highlights the importance of the role of speech and language pathology in working with parents of toddlers and children who were adopted internationally. This role is in health promotion and prevention, as well as providing a service to this population as part of a multidisciplinary team, post-adoption.

Language Development in Children With Cleft Palate With or Without Cleft Lip Adopted From Non-English-Speaking Countries

PURPOSE

The purpose of this study was to determine whether language skills differed between children with cleft palate or cleft lip and palate (CP±CL) who were adopted into an English-speaking home from a non-English-speaking country (late English exposure [LE]) and children with CP±CL raised from birth in an English-speaking home (early English exposure [EE]).

METHOD

Children (51 LE, 67 EE), ages 3;0 (years;months) to 9;0, completed the Clinical Evaluation of Language Fundamentals (CELF), Preschool Second Edition or Fourth Edition. Linear regression analysis was used to assess the impact of age of adoption and time in an English-speaking home on language skills, as measured by the CELF-P2 and CELF-4.

RESULTS

Children with CP±CL who were adopted scored less well on all language indices, with mean adjusted differences between LE and EE children ranging from 0.4 to 0.7 SD on the CELF index scales. Only 53% of the EE children and 57% of the LE children obtained scores above 90 on all indices. For LE children, younger age at adoption was associated with better language skills.

CONCLUSION

CP±CL increases risk for language delay, with the highest risk for LE children. LE children with CP±CL should receive language services soon after adoption.

Potential short-term neurobehavioral alterations in children associated with a peak pesticide spray season: The Mother's Day flower harvest in Ecuador

BACKGROUND

Exposures to cholinesterase inhibitor pesticides (e.g. organophosphates) have been associated with children's neurobehavioral alterations, including attention deficit and impulsivity. Animal studies have observed transient alterations in neurobehavioral performance in relation to cholinesterase inhibitor pesticide exposures; however, limited evidence exists regarding transient effects in humans.

METHODS

We estimated the associations between neurobehavioral performance and time after Mother's Day flower harvest (the end of a heightened pesticide usage period) among 308 4-to 9-year-old children living in floricultural communities in Ecuador in 2008 who participated in the ESPINA study. Children's neurobehavior was examined once (NEPSY-II: 11 subtests covering 5 domains), between 63 and 100days (SD: 10.8days) after Mother's Day harvest (blood acetylcholinesterase activity levels can take 82days to normalize after irreversible inhibition with organophosphates).

RESULTS

The mean (SD) neurobehavioral scaled scores across domains ranged from 6.6 (2.4) to 9.9 (3.3); higher values reflect greater performance. Children examined sooner after Mother's Day had lower neurobehavioral scores than children examined later, in the domains of (score difference per 10.8days, 95%CI): Attention/Inhibitory Control (0.38, 0.10-0.65), Visuospatial Processing (0.60, 0.25-0.95) and Sensorimotor (0.43, 0.10-0.77). Scores were higher with longer time post-harvest among girls (vs. boys) in Attention/Inhibitory Control.

CONCLUSIONS

Our findings, although cross-sectional, are among the first in non-worker children to suggest that a peak pesticide use period may transiently affect neurobehavioral performance, as children examined sooner after the flower harvest had lower neurobehavioral performance than children examined later. Studies assessing pre- and post-exposure measures are needed.

Social communication difficulties and autism in previously institutionalized children

OBJECTIVE

To determine the risk of difficulties with social communication and restricted/repetitive behaviors as well as the rate of autism in children institutionalized in early infancy and to assess the impact of a foster care intervention on ameliorating this risk.

METHOD

Children abandoned at birth and raised in institutions in Bucharest, Romania were randomly assigned to a care-as-usual group (institutional care, CAUG), or placed in family-centered foster care (FCG) as part of the Bucharest Early Intervention Project (BEIP). At approximately 10 years of age, the Social Communication Questionnaire (SCQ) was administered to caregivers of children in both groups as well as to parents of a typically developing community sample (Never-Institutionalized group [NIG]) residing in Bucharest, Romania. Children scoring ≥12 on the SCQ underwent clinical evaluation for autism spectrum disorder (ASD).

RESULTS

Caregivers of children with a history of institutionalization reported that these children had significantly more deviant behavior than never-institutionalized children on all subdomains of the SCQ (all p < 0.001). Children in the FCG had significantly lower scores on the SCQ than children in the CAUG (p < .001), particularly in the reciprocal social interaction domain, indicating that the intervention reduced problems in social communication. Three of 60 CAUG children, 2 of 57 FCG children, and none of the NIG children received a formal ASD diagnosis.

CONCLUSION

Early institutional rearing was associated with an increased risk of social communication difficulties and ASD. A family-centered foster care intervention improved social communication skills.

Internationally Adopted Children in the Early School Years: Relative Strengths and Weaknesses in Language Abilities

Purpose

This study aimed to determine the relative strengths and weaknesses in language and verbal short-term memory abilities of school-age children who were adopted from Eastern Europe.

Method

Children adopted between 1;0 and 4;11 (years;months) of age were assessed with the Clinical Evaluation of Language Fundamentals—Preschool, Second Edition (CELF–P2) and the Clinical Evaluation of Language Fundamentals, Fourth Edition (CELF–4) at age 5 and ages 6–7. Language composites and subtests were compared across time.

Results

All CELF–P2 and CELF–4 mean scores fell in the average range. Receptive composites were 102.74 and 103.86, and expressive composites were 100.58 and 98.42, at age 5 and ages 6–7, respectively. Age of adoption did not correlate to test scores. At ages 6–7, receptive language, sentence formulation, and vocabulary were areas of strength, with subtest scores significantly better than test norms. Verbal short-term memory and expressive grammar subtest scores were within the average range but significantly worse than test norms. A high percentage of children scored 1 standard deviation below the mean on these 2 subtests (27.3%–34.1%).

Conclusion

Eastern European adoptees had average scores on a variety of language tests. Vocabulary was a relative strength; enriching the environment substantially improved this language area. Verbal short-term memory and expressive grammar were relative weaknesses. Children learning a language later in life may have difficulty with verbal short-term memory, which leads to weaknesses in expressive syntax and grammar.

Effects of early institutionalization on the development of emotion processing: a case for relative sparing?

We tested the capacity to perceive visual expressions of emotion, and to use those expressions as guides to social decisions, in three groups of 8- to 10-year-old Romanian children: children abandoned to institutions then randomly assigned to remain in 'care as usual' (institutional care); children abandoned to institutions then randomly assigned to a foster care intervention; and community children who had never been institutionalized. Experiment 1 examined children's recognition of happy, sad, fearful, and angry facial expressions that varied in intensity. Children assigned to institutional care had higher thresholds for identifying happy expressions than foster care or community children, but did not differ in their thresholds for identifying the other facial expressions. Moreover, the error rates of the three groups of children were the same for all of the facial expressions. Experiment 2 examined children's ability to use facial expressions of emotion to guide social decisions about whom to befriend and whom to help. Children assigned to institutional care were less accurate than foster care or community children at deciding whom to befriend; however, the groups did not differ in their ability to decide whom to help. Overall, although there were group differences in some abilities, all three groups of children performed well across tasks. The results are discussed in the context of theoretical accounts of the development of emotion processing.

A Longitudinal Study of Language and Speech in Children Who Were Internationally Adopted at Different Ages

Purpose

The author followed 56 internationally adopted children during the first 3 years after adoption to determine how and when they reached age-expected language proficiency in Standard American English. The influence of age of adoption was measured, along with the relationship between early and later language and speech outcomes.

Method

Children adopted from Eastern Europe at ages 12 months to 4 years, 11 months, were assessed 5 times across 3 years. Norm-referenced measures of receptive and expressive language and articulation were compared over time. In addition, mean length of utterance (MLU) was measured.

Results

Across all children, receptive language reached age-expected levels more quickly than expressive language. Children adopted at ages 1 and 2 “caught up” more quickly than children adopted at ages 3 and 4. Three years after adoption, there was no difference in test scores across age of adoption groups, and the percentage of children with language or speech delays matched population estimates. MLU was within the average range 3 years after adoption but significantly lower than other language test scores.

Conclusions

Three years after adoption, age of adoption did not influence language or speech outcomes, and most children reached age-expected language levels. Expressive syntax as measured by MLU was an area of relative weakness.

Motor outcomes in children exposed to early psychosocial deprivation

OBJECTIVES

To determine the effect of psychosocial deprivation early in life on motor development, assess the impact of a foster care intervention on improving motor development, and assess the association between motor and cognitive outcomes in children with a history of institutional care.

STUDY DESIGN

In a randomized controlled trial, children living in Romanian institutions were randomly assigned to care as usual in the institution or placed in family-centered foster care as part of the Bucharest Early Intervention Project. The average age at placement into foster care was 23 months. At age 8 years, the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, Short Form (BOT2-SF) was applied to assess the motor proficiency of children in both groups, as well as a never-institutionalized group from the Romanian community.

RESULTS

Children in the never-institutionalized group did significantly better on the BOT2-SF than children who had ever been institutionalized (P < .001). There was no significant difference in performance between children in the care as usual group and the foster care group. This finding also held true for all individual items on the BOT2-SF except sit-ups. Regression analyses revealed that the between-group and within-group differences in BOT2-SF scores were largely mediated by IQ.

CONCLUSION

Early deprivation had a negative effect on motor development that was not resolved by placement in foster care. This effect was predominantly mediated by IQ. This study highlights the importance of monitoring for and addressing motor delays in children with a history of institutionalization, particularly those children with low IQ.

Effect of foster care on language learning at eight years: findings from the Bucharest Early Intervention Project

This study reports on language outcomes at eight years from the Bucharest Early Intervention Project, a randomized controlled study of foster care. We previously have shown that children placed in foster care by age two have substantially stronger preschool language outcomes than children placed later and children remaining in institutional care. One hundred and five children participated in the current study, fifty-four originally assigned to foster care and fifty-one to continued institutional care. Even though current placements varied, children originally in foster care had longer sentences and stronger sentence repetition and written word identification. Children placed in foster care by age two had significant advantages in word identification and nonword repetition; children placed by age 1 ; 3 performed equivalently to community peers. The results show the continuing adverse effects of early poor institutional care on later language development and the key importance of age of placement in a more optimal environment.

Emotion recognition following early psychosocial deprivation

An important function of the brain is to scan incoming sensory information for the presence of relevant signals and act on this information. For humans, the most salient signals are often social in nature, such as the identity and the emotional expression of the faces we encounter in our everyday lives. It can be argued that our survival as a species depends in large measure on these skills.

A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder

OBJECTIVE

The authors examined signs of emotionally withdrawn (inhibited type) and indiscriminately social (disinhibited type) reactive attachment disorder in Romanian children enrolled in a randomized trial of foster care compared with institutional care and in a comparison group of never-institutionalized children.

METHOD

At baseline and when children were ages 30, 42, and 54 months and 8 years, caregivers were interviewed with the Disturbances of Attachment Interview to assess changes in signs of reactive attachment disorder in three groups of children: those receiving care as usual (including continued institutional care) (N=68); those placed in foster care after institutional care (N=68); and those who were never institutionalized (N=72). The impact of gender, ethnicity, and baseline cognitive ability was also examined.

RESULTS

On the Disturbances of Attachment Interview, signs of the inhibited type of reactive attachment disorder decreased after placement in foster care, and scores were indistinguishable from those of never-institutionalized children after 30 months. Signs of the disinhibited type were highest in the usual care group, lower in the foster care group, and lowest in the never-institutionalized group. Early placement in foster care (before age 24 months) was associated with fewer signs of the disinhibited type. Lower baseline cognitive ability was associated with more signs of the inhibited type in the usual care group and more signs of the disinhibited type in both groups.

CONCLUSIONS

Signs of the inhibited type of reactive attachment disorder responded quickly to placement in foster care; signs of the disinhibited type showed less robust resolution with foster placement. Lower baseline cognitive ability was linked to signs of reactive attachment disorder.

The timing of educational investment: a neuroscientific perspective

Economic models of investment in human capital sometimes refer to neuroscience as a means to support their underlying assumptions regarding human development. These assumptions have a crucial influence on the policy implications the models generate. We review the extent to which the neuroscience of development can be used to support a "learning begets learning" principle of human capital accumulation. We conclude that, although early neural development can be considered as foundational, it cannot be considered as a unitary phenomenon that proceeds in continuous fashion. Furthermore, the concept of the sensitive period, which is often used associated with the principle, suggests benefits of investment depend upon an individual's circumstances and developmental history, and particularly whether this can be classified as normal. A more recent model of investment has involved two different types of abilities, with outcomes demonstrating the value of including more sophisticated assumptions about human development. We conclude that, while current discussions of policy would benefit from a more careful interpretation of existing models, the potential for future work combining modern neuroscientific understanding with economic theory is considerable.

The Effects of Early Neglect on Cognitive, Language, and Behavioral Functioning in Childhood

OBJECTIVES

Few studies have explored the impact of different types of neglect on children's development. Measures of cognition, language, behavior, and parenting stress were used to explore differences between children experiencing various forms of neglect, as well as to compare children with and without a history of early neglect.

METHODS

Children, ages 3 to 10 years with a history of familial neglect (USN), were compared to children with a history of institutional rearing (IA) and children without a history of neglect using the Differential Abilities Scale, Test of Early Language Development, Child Behavior Checklist, and Parenting Stress Index. Factors predicting child functioning were also explored.

RESULTS

Compared with youth that were not neglected, children with a history of USN and IA demonstrated lower cognitive and language scores and more behavioral problems. Both internalizing and externalizing behavior problems were most common in the USN group. Externalizing behavior problems predicted parenting stress. Higher IQ could be predicted by language scores and an absence of externalizing behavior problems. When comparing the two neglect groups, shorter time spent in a stable environment, lower scores on language skills, and the presence of externalizing behavior predicted lower IQ.

CONCLUSION

These findings emphasize the importance of early stable, permanent placement of children who have been in neglectful and pre-adoptive international settings. While an enriching environment may promote resilience, children who have experienced early neglect are vulnerable to cognitive, language and behavioral deficits and neurodevelopmental and behavioral evaluations are required to identify those in need of intervention.

The Neurobiological Toll of Early Human Deprivation

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

IV. Growth Failure in Institutionalized Children

Children within institutional care settings experience significant global growth suppression, which is more profound in children with a higher baseline risk of growth impairment (e.g., low birth weight [LBW] infants and children exposed to alcohol in utero). Nutritional insufficiencies as well as suppression of the growth hormone-insulin-like growth factor axis (GH-IGF-1) caused by social deprivation likely both contribute to the etiology of psychosocial growth failure within these settings. Their relative importance and the consequent clinical presentations probably relate to the age of the child. While catch-up growth in height and weight are rapid when children are placed in a more nurturing environment, many factors, particularly early progression through puberty, compromise final height. Potential for growth recovery is greatest in younger children and within more nurturing environments where catch-up in height and weight is positively correlated with caregiver sensitivity and positive regard. Growth recovery has wider implications for child well-being than size alone, because catch-up in height is a positive predictor of cognitive recovery as well. Even with growth recovery, persistent abnormalities of the hypothalamic-pituitary-adrenal system or the exacerbation of micronutrient deficiencies associated with robust catch-up growth during critical periods of development could potentially influence or be responsible for the cognitive, behavioral, and emotional sequelae of early childhood deprivation. Findings in growth-restricted infants and those children with psychosocial growth are similar, suggesting that children experiencing growth restriction within institutional settings may also share the risk of developing the metabolic syndrome in adulthood (obesity, Type 2 diabetes mellitus, hypertension, heart disease). Psychosocial deprivation within any care-giving environment during early life must be viewed with as much concern as any severely debilitating childhood disease.

Research, Practice, and Policy Perspectives on Issues of Children without Permanent Parental Care

This chapter presents conclusions, trends, conceptual analyses, hypotheses, and speculations regarding some fundamental issues of research, practice, and policy that are largely unsettled or controversial. As such, the chapter is not a summary of Chapters 1-8, but rather contains interpretations and opinions of the author intended to elevate the priority of certain issues, suggest hypotheses to be studied, and propose practice and policy steps to be considered.

Research, Practice, and Policy Perspectives on Issues of Children without Permanent Parental Care

This chapter presents conclusions, trends, conceptual analyses, hypotheses, and speculations regarding some fundamental issues of research, practice, and policy that are largely unsettled or controversial. As such, the chapter is not a summary of Chapters 1-8, but rather contains interpretations and opinions of the author intended to elevate the priority of certain issues, suggest hypotheses to be studied, and propose practice and policy steps to be considered.

IV. Growth Failure in Institutionalized Children

Children within institutional care settings experience significant global growth suppression, which is more profound in children with a higher baseline risk of growth impairment (e.g., low birth weight [LBW] infants and children exposed to alcohol in utero). Nutritional insufficiencies as well as suppression of the growth hormone-insulin-like growth factor axis (GH-IGF-1) caused by social deprivation likely both contribute to the etiology of psychosocial growth failure within these settings. Their relative importance and the consequent clinical presentations probably relate to the age of the child. While catch-up growth in height and weight are rapid when children are placed in a more nurturing environment, many factors, particularly early progression through puberty, compromise final height. Potential for growth recovery is greatest in younger children and within more nurturing environments where catch-up in height and weight is positively correlated with caregiver sensitivity and positive regard. Growth recovery has wider implications for child well-being than size alone, because catch-up in height is a positive predictor of cognitive recovery as well. Even with growth recovery, persistent abnormalities of the hypothalamic-pituitary-adrenal system or the exacerbation of micronutrient deficiencies associated with robust catch-up growth during critical periods of development could potentially influence or be responsible for the cognitive, behavioral, and emotional sequelae of early childhood deprivation. Findings in growth-restricted infants and those children with psychosocial growth are similar, suggesting that children experiencing growth restriction within institutional settings may also share the risk of developing the metabolic syndrome in adulthood (obesity, Type 2 diabetes mellitus, hypertension, heart disease). Psychosocial deprivation within any care-giving environment during early life must be viewed with as much concern as any severely debilitating childhood disease.

Postcommunist Deinstitutionalization of Children With Disabilities in Romania

The author examines the policies and treatment of children institutionalized during and after the communist regime, the adoption policies for these children, the human rights claimed in the name of these children, and the ecology of disabilities in Romania. Institutionalized children fell into three categories: children who had one or more minor to severe disabilities, children who had been abandoned, and children who were part of ethnic minorities, especially the Roma. The author reviews the literature on these topics and adds her own perspective, as a Romanian special education teacher and researcher. While during communism, institutionalized persons were invisible to the public and kept in inhuman conditions, after communism, increased awareness about the situation in state institutions and about disabilities and human rights in general led to the adoption and implementation of new disability-friendly policies. Currently, there is increased advocacy for the rights of the people with disabilities, although great challenges remain.

Effect of foster care on young children's language learning

This report examines 174 young children's language outcomes in the Bucharest Early Intervention Project, the first randomized trial of foster placement after institutional care. Age of foster placement was highly correlated with language outcomes. Placement by 15 months led to similar expressive and receptive language test scores as typical age peers at 30 and 42 months. Placement from 15 to 24 months also led to dramatic language improvement. In contrast, children placed after 24 months had the same severe language delays as children in institutional care. Language samples at 42 months confirmed that placement after 24 months led to lower expressive skill.

Language and cognitive outcomes in internationally adopted children

This study focuses on the association between language skills and core cognitive processes relative to the duration of institutionalization in children adopted from orphanages abroad. Participants in the adoptive group (n = 46) had arrived in the United States between the ages of 2 and 84 months (mean = 24 months), and had been living in the United States for 1–9 years. Drawing on both experimental and standardized assessments, language skills of the international adoptees differed as a function of length of time spent in an institution and from those of 24 nonadopted controls. Top-down cognitive assessments including measures of explicit memory and cognitive control differed between adopted and nonadopted children, yet differences between groups in bottom-up implicit learning processes were unremarkable. Based on the present findings, we propose a speculative model linking language and cognitive changes to underlying neural circuitry alterations that reflect the impact of chronic stress, due to adoptees' experience of noncontingent, nonindividualized caregiving. Thus, the present study provides support for a relationship between domain-general cognitive processes and language acquisition, and describes a potential mechanism by which language skills are affected by institutionalization.

How the timing and quality of early experiences influence the development of brain architecture

Early life events can exert a powerful influence on both the pattern of brain architecture and behavioral development. In this study a conceptual framework is provided for considering how the structure of early experience gets "under the skin." The study begins with a description of the genetic framework that lays the foundation for brain development, and then proceeds to the ways experience interacts with and modifies the structures and functions of the developing brain. Much of the attention is focused on early experience and sensitive periods, although it is made clear that later experience also plays an important role in maintaining and elaborating this early wiring diagram, which is critical to establishing a solid footing for development beyond the early years.

Communication Development and Differences in Children Adopted From China and Eastern Europe

Purpose

The communication development of children adopted from China and Eastern Europe was compared by region of origin at 6 and 12 months after adoption.

Method

Twenty children, recruited before or immediately following their adoption, participated in the study. Measures were collected between 2 and 6 months after adoption (Time 1) and between 12 and 14 months after adoption (Time 2). The children’s ages ranged between 11–22 months and 22–34 months, respectively. Parent-reported vocabulary comprehension and expression and behavioral communication assessments were administered.

Results

No significant differences between region of origin were found at Time 1. At Time 2, significant group differences in expressive language performance were found, with children adopted from China and Eastern Europe demonstrating different patterns of English language development.

Conclusion

Early prelinguistic measures may provide prognostic indicators for later English language development. Children adopted from different countries where they are initially exposed to different birth languages may acquire English differently.

Growth and associations between auxology, caregiving environment, and cognition in socially deprived Romanian children randomized to foster vs ongoing institutional care

OBJECTIVES

To determine effects of improved nurturing compared with institutional care on physical growth and to investigate the association between growth and cognitive development.

DESIGN

A randomized controlled trial beginning in infants (mean age, 21.0 months; range, 5-32 months), with follow-up at 30, 42, and 54 months of age.

SETTING

Institutionalized and community children in Bucharest, Romania.

PARTICIPANTS

One hundred thirty-six healthy institutionalized children from 6 orphanages and 72 typically developing, never-institutionalized children.

INTERVENTION

Institutionalized children were randomly assigned to receive foster care or institutional care as usual.

OUTCOME MEASURES

Auxology and measures of intelligence over time.

RESULTS

Growth in institutionalized children was compromised, particularly in infants weighing less than 2500 g at birth. Mean height and weight, though not head size, increased to near normal within 12 months in foster care. Significant independent predictors for greater catch-up in height and weight included age younger than 12 months at randomization, lower baseline z scores, and higher caregiving quality, particularly caregiver sensitivity and positive regard. Baseline developmental quotient, birth weight, and height catch-up were significant independent predictors of cognitive abilities at follow-up. Each incremental increase of 1 in standardized height scores between baseline and 42 months was associated with a mean increase of 12.6 points (SD, 4.7 points) in verbal IQ (P < .05).

CONCLUSIONS

Foster care had a significant effect on growth, particularly with early placement and high-quality care. Growth and IQ in low-birth-weight children are particularly vulnerable to social deprivation. Catch-up growth in height under more nurturing conditions is a useful indicator of caregiving quality and cognitive improvement.

Modification of depression by COMT val158met polymorphism in children exposed to early severe psychosocial deprivation

OBJECTIVE

To examine the impact of the catechol-O-methyltransferase (COMT) val(158)met allele on depressive symptoms in young children exposed to early severe social deprivation as a result of being raised in institutions.

METHODS

One hundred thirty six children from the Bucharest Early Intervention Project (BEIP) were randomized before 31 months of age to either care as usual (CAU) in institutions or placement in newly created foster care (FCG). At 54 months of age, a psychiatric assessment using the Preschool Age Psychiatric Assessment (PAPA) was completed. DNA was collected and genotyped for the COMT val(158)met polymorphism. Multivariate analysis examined the relationship between COMT alleles and depressive symptoms.

RESULTS

Mean level of depressive symptoms was lower among participants with the met allele compared to those with two copies of the val allele (P<0.05). Controlling for group and gender, the rate of depressive symptoms was significantly lower among participants with the met/met or the met/val genotype [adjusted relative risk (aRR)=0.67, 95% CI=0.45, 0.99] compared to participants with the val/val genotype, indicating an intermediate impact for heterozygotes consistent with the biological impact of this polymorphism. The impact of genotype within groups differed significantly. There was a significant protective effect of the met allele on depressive symptoms within the CAU group, however there was no relationship seen within the FCG group.

CONCLUSIONS

This is the first study, to our knowledge, to find evidence of a genexenvironment interaction in the setting of early social deprivation. These results support the hypothesis that individual genetic differences may explain some of the variability in recovery amongst children exposed to early severe social deprivation.

The Effects of Early Institutionalization on the Discrimination of Facial Expressions of Emotion in Young Children

The current study examined the effects of institutionalization on the discrimination of facial expressions of emotion in 3 groups of 42-month-old children. One group consisted of children abandoned at birth who were randomly assigned to Care as Usual (institutional care) following a baseline assessment. Another group consisted of children abandoned at birth who were randomly assigned to high-quality foster care following a baseline assessment. A third group consisted of never-institutionalized children who were reared by their biological parents. All children were familiarized to happy, sad, fearful, and neutral facial expressions and tested on their ability to discriminate familiar versus novel facial expressions. Contrary to our prediction, all three groups of children were equally able to discriminate among the different expressions. Furthermore, in contrast to findings at 13-30 months of age, these same children showed familiarity rather than novelty preferences toward different expressions. There were also asymmetries in children's discrimination of facial expressions depending on which facial expression served as the familiar versus the novel stimulus. Collectively, early institutionalization appears not to impact the development of the ability to discriminate facial expressions of emotion, at least when preferential looking serves as the dependent measure. These findings are discussed in the context of the myriad domains that are affected by early institutionalization.

Neurodevelopmental effects of early deprivation in postinstitutionalized children

The neurodevelopmental sequelae of early deprivation were examined by testing (N = 132) 8- and 9-year-old children who had endured prolonged versus brief institutionalized rearing or rearing in the natal family. Behavioral tasks included measures that permit inferences about underlying neural circuitry. Children raised in institutionalized settings showed neuropsychological deficits on tests of visual memory and attention, as well as visually mediated learning and inhibitory control. Yet, these children performed at developmentally appropriate levels on similar tests where auditory processing was also involved and on tests assessing executive processes such as rule acquisition and planning. These findings suggest that specific aspects of brain-behavioral circuitry may be particularly vulnerable to postnatal experience.

Early communication development in socially deprived children — similar to autism?

Social deprivation leads to various neuroanatomical, neuropsychological and behavioral disturbances in humans as well as in experimental animals. Shared characteristics of socially deprived subjects and subjects with autism have been documented. The aim of this study was to analyze early development of communication in institutionalized (INST) children (12–24 months) in comparison with age- and sexmatched group of typically developing (TD) children and a group of children with autism spectrum disorders (ASD). Our findings show that both socially deprived (INST) children and ASD children display delayed pattern of development in social, speech and symbolic domains. However, although INST children display significant developmental delay and share some features with ASD children, they have a qualitatively different developmental pattern of social communication in comparison to children with ASD. The results of this study indicate that growing up in an institution and lack of social and environmental stimuli influences development of skills that are fundamental for early speech and language development.

Effects of early intervention on EEG power and coherence in previously institutionalized children in Romania

Two groups of Romanian children were compared on spectral power and coherence in the electroencephalogram (EEG) in early childhood. One group consisted of previously institutionalized children who had been randomly assigned to a foster care intervention at a mean age of 23 months. The second group had been randomized to remain in institutional care. Because of a policy of noninterference, a number of these children also experienced placement into alternative family care environments. There were minimal group differences between the foster care and institutionalized groups in EEG power and coherence across all measured frequency bands at 42 months of age. However, age at foster care placement within the foster care group was correlated with certain measures of EEG power and coherence. Earlier age at foster care placement was associated with increased alpha power and decreased short-distance EEG coherence. Further analyses separating age at placement from duration of intervention suggest that this effect may be more robust for EEG coherence than EEG band power. Supplementary analyses examined whether the EEG measures mediated changes in intellectual abilities within the foster care children, but no clear evidence of mediation was observed.