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Oliveira PS, Fearon P, Belsky J, Mesquita AR, Sampaio A, Pinal D, Soares I. Neural correlates of face familiarity in institutionalised children and links to attachment disordered behaviour. J Child Psychol Psychiatry 2022; 64:736-746. [PMID: 36457167 DOI: 10.1111/jcpp.13728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 12/04/2022]
Abstract
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.
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Affiliation(s)
- Paula S Oliveira
- Anna Freud National Centre for Children and Families & Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Pasco Fearon
- Department of Psychology, Cambridge, and Anna Freud National Centre for Children and Families, London, UK
| | - Jay Belsky
- University of California, Davis, CA, USA
| | - Ana R Mesquita
- School of Psychology, University of Minho, Braga, Portugal
| | | | - Diego Pinal
- School of Psychology, University of Minho, Braga, Portugal
| | - Isabel Soares
- School of Psychology, University of Minho, Braga, Portugal
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2
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Sonuga-Barke EJS, Hanć T, Stehli A, Trampush JW, Kennedy M, Kreppner J, Rutter M, Swanson JM. Severe deprivation in early childhood leads to permanent growth stunting: Longitudinal analysis of height trajectories from childhood-to-adulthood. CHILD ABUSE & NEGLECT 2022; 123:105427. [PMID: 34896879 DOI: 10.1016/j.chiabu.2021.105427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/11/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Childhood institutional deprivation is associated with growth stunting in childhood but long-term effects in adulthood remain uncertain. OBJECTIVE To examine the impact of global institutional deprivation experienced in early childhood on subsequent growth with a special focus on final adult height and puberty timing. PARTICIPANTS & SETTING The study was originally set in the UK, though some adoptive families lived abroad by the time of the adult follow up. 165 individuals adopted by UK families before 43 months of age from Romanian orphanages after the fall of the Ceaușescu regime in the early 1990's were compared to 51 non-deprived UK adoptees, adopted before the age of 6 months. METHODS The English and Romanian Adoptees (ERA) study is a 20-year longitudinal natural experiment on the effects of institutional deprivation on development. Key growth milestones were extracted from growth curve modelling of height data collected at ages 4, 6, 11, 15 and 23 years using a Bayesian approach to fit the JPA2 model. RESULTS Deprivation effects on height were present at the take-off point of accelerating adolescent growth and persisted into adulthood - the largest effects being for individuals who experienced over six months of deprivation. Deprivation was associated with earlier take-off and achievement of peak height velocity of adolescent growth acceleration - an effect driven largely by females' data and correlated with parent ratings of pubertal development. CONCLUSIONS Early deprivation appears to reset tempo of growth early in development leading to permanent growth stunting in adulthood and accelerated onset of puberty, specifically in females.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, DeCrespigny Park, London SE5 8AF, UK; Department of Child & Adolescent Psychiatry, Aarhus University, Denmark.
| | - Tomasz Hanć
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, ul. Uniwersytetu Poznanskiego 6, 61-614 Poznan, Poland
| | - Annamarie Stehli
- Department of Pediatrics, University of California, Irvine, 333 The City Blvd. West, Suite 800, Orange, CA 92868-4482, USA
| | - Joey W Trampush
- Department of Psychiatry and the Behavioural Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, USA
| | - Mark Kennedy
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, DeCrespigny Park, London SE5 8AF, UK
| | - Jana Kreppner
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Michael Rutter
- Social, Developmental, Genetic Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, DeCrespigny Park, London, SE5 8AF, UK
| | - James M Swanson
- Department of Pediatrics, University of California, Irvine, 333 The City Blvd. West, Suite 800, Orange, CA 92868-4482, USA
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Choy O, Raine A. Vitamin D sufficiency attenuates the effect of early social adversity on child antisocial behavior. Psychol Med 2021; 52:1-10. [PMID: 33762031 DOI: 10.1017/s0033291721001069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vitamin D insufficiency and child antisocial behavior are public health concerns. It is unknown whether vitamin D plays a role in antisocial outcomes. This study examines whether higher levels of vitamin D can act as a protective factor against antisocial behavior for children who are exposed to early social adversity. METHODS In a community sample of 300 children aged 11-12 years (151 females, 149 males), serum concentrations of 25-hydroxyvitamin D [25(OH)D] were assessed alongside early social adversity, and both parent and child-reported antisocial behavior. RESULTS Vitamin D moderated the association between early social adversity and multiple antisocial outcomes. Higher social adversity was associated with greater antisocial behavior among vitamin D-insufficient [25(OH)D < 30 ng/mL], but not vitamin D-sufficient children [25(OH)D ⩾ 30 ng/mL], after adjusting for other variables. Results from child reports of antisocial behavior were replicated with parent reports, providing support for the robustness of the findings. At serum 25(OH)D concentrations above 27.16-30.69 ng/mL (close to 30 ng/mL, the recommended optimal vitamin D level for pediatric populations), the effect of social adversity on antisocial behavior outcomes was nullified. CONCLUSIONS To our knowledge, this study is the first to document that a nutritional factor, vitamin D, can potentially confer resilience to antisocial behavior. Our findings in a pediatric population suggest a possible role of vitamin D supplementation in interventions to reduce antisocial behavior, which may be further investigated in future randomized controlled trials.
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Affiliation(s)
- Olivia Choy
- Department of Psychology, Nanyang Technological University, 48 Nanyang Avenue, Singapore, 639818, Singapore
| | - Adrian Raine
- Departments of Criminology, Psychiatry, and Psychology, University of Pennsylvania, McNeil Building, 3718 Locust Walk, Philadelphia, PA19104, USA
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Ivey R, Kerac M, Quiring M, Dam HT, Doig S, DeLacey E. The Nutritional Status of Individuals Adopted Internationally as Children: A Systematic Review. Nutrients 2021; 13:245. [PMID: 33467102 PMCID: PMC7829835 DOI: 10.3390/nu13010245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Since 1955, international adoption has been a way of finding homes for children who have been orphaned or abandoned. We aimed to describe the nutritional status of individuals adopted internationally and their long-term nutritional and health outcomes. We searched four databases for articles published from January 1995 to June 2020, which included information on anthropometric or micronutrient status of children adopted internationally (CAI). Mean Z-scores on arrival to adoptive country ranged from -2.04 to -0.31 for weight for age; -0.94 to 0.39 for weight for height; -0.7 to 0 for body mass index; -1.89 to -0.03 for height for age; -1.43 to 0.80 for head circumference for age. Older children, those adopted from institutionalized care or with underlying disability, were more likely to be malnourished. Though long-term data was scarce, mean Z-scores post-adoption ranged from -0.59 to 0.53 for weight for age; -0.31 to 1.04 for weight for height; 0.39 to 1.04 for body mass index; -1.09 to 0.58 for height for age; -0.06 to 1.23 for head circumference for age. We conclude that though CAI are at high risk of malnutrition at baseline, marked catch-up growth is possible, including for those older than two years of age on arrival. This has implications not only for CAI but for the wider population of malnourished children worldwide. Research on how to optimize catch-up growth is a priority.
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Affiliation(s)
- Richard Ivey
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK; (M.K.); (E.D.)
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK
| | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK; (M.K.); (E.D.)
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK
| | - Michael Quiring
- Holt International, Eugene, OR 97401, USA; (M.Q.); (H.T.D.); (S.D.)
| | - Hang T. Dam
- Holt International, Eugene, OR 97401, USA; (M.Q.); (H.T.D.); (S.D.)
| | - Susie Doig
- Holt International, Eugene, OR 97401, USA; (M.Q.); (H.T.D.); (S.D.)
| | - Emily DeLacey
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK; (M.K.); (E.D.)
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK
- Holt International, Eugene, OR 97401, USA; (M.Q.); (H.T.D.); (S.D.)
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van IJzendoorn MH, Bakermans-Kranenburg MJ, Duschinsky R, Fox NA, Goldman PS, Gunnar MR, Johnson DE, Nelson CA, Reijman S, Skinner GCM, Zeanah CH, Sonuga-Barke EJS. Institutionalisation and deinstitutionalisation of children 1: a systematic and integrative review of evidence regarding effects on development. Lancet Psychiatry 2020; 7:703-720. [PMID: 32589867 DOI: 10.1016/s2215-0366(19)30399-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Marinus H van IJzendoorn
- Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands; Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Robbie Duschinsky
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nathan A Fox
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Dana E Johnson
- Divisions of Neonatology and Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Charles A Nelson
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Harvard Graduate School of Education, Cambridge, MA, USA
| | - Sophie Reijman
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Guy C M Skinner
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Charles H Zeanah
- Institute of Infant and Early Childhood Mental Health, Tulane University School of Medicine, New Orleans, LA, USA
| | - Edmund J S Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK; Department of Child and Adolescent Psychiatry, Aarhus University, Aarhus, Denmark.
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Early childhood deprivation is associated with alterations in adult brain structure despite subsequent environmental enrichment. Proc Natl Acad Sci U S A 2020; 117:641-649. [PMID: 31907309 PMCID: PMC6955353 DOI: 10.1073/pnas.1911264116] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
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.
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7
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Jones-Mason K, Behrens KY, Gribneau Bahm NI. The psychobiological consequences of child separation at the border: lessons from research on attachment and emotion regulation. Attach Hum Dev 2019; 23:1-36. [PMID: 31769354 DOI: 10.1080/14616734.2019.1692879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Karen Jones-Mason
- Department of Psychiatry, Center for Health and Community, University of California , San Francisco, USA
| | - Kazuko Y Behrens
- Department of Social & Behavioral Sciences, State University of New York Polytechnic Institute , Utica, NY, USA
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8
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Julian MM, McCall RB, Groark CJ, Muhamedrahimov RJ, Palmov OI, Nikiforova NV. Development of children adopted to the United States following a social-emotional intervention in St. Petersburg (Russian Federation) institutions. APPLIED DEVELOPMENTAL SCIENCE 2018; 23:273-293. [PMID: 31488944 PMCID: PMC6727650 DOI: 10.1080/10888691.2017.1420480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study is a post-adoption follow-up of a social-emotional intervention in St. Petersburg, Russian Federation Baby Homes (BHs). Children previously resided in BHs and received Care as Usual (CAU, N=220), Training Only (TO, N=94), or Training plus Structural Changes (T+SC, N=45). This study examined intervention effects 0-6.5 years post-adoption to the USA, at age 9 months to 7 years old. Adoptive parents completed questionnaires on their child's social and behavioral development. Intervention graduates had better attachment security, less indiscriminate friendliness, and fewer behavior problems than CAU graduates. Children who had longer exposure to intervention conditions had better attachment security, but poorer executive function, externalizing and internalizing problems, and competence. Thus, although post-institutionalized children were generally functioning in the normal range in early childhood and effect sizes were small, a social-emotional intervention in institutions is associated with modest benefits to attachment and behavior problems and apparent decrements to executive function.
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9
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Thakur A, Creedon J, Zeanah CH. Trauma- and Stressor-Related Disorders Among Children and Adolescents. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2016; 14:34-45. [PMID: 31975792 PMCID: PMC6524445 DOI: 10.1176/appi.focus.20150026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
DSM-5 introduced a clustering of disorders designated "trauma- and stressor-related disorders." These disorders are unique in that the etiology is specified as part of the diagnostic criteria. In this review, the authors consider how some of these disorders manifest for children and adolescents. In posttraumatic stress disorder and related disorders, the child is exposed to one or more frightening, traumatic events. In attachment disorders, the child experiences severe social neglect. With this framework in mind, the authors consider details of several prominent trauma- and stressor-related disorders that arise in response to either excessive, unwanted input or inadequate, necessary input among children and adolescents.
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Affiliation(s)
- Akanksha Thakur
- The authors are with the Section of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jennifer Creedon
- The authors are with the Section of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - Charles H Zeanah
- The authors are with the Section of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
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Julian MM, McCall RB. Social Skills in Children Adopted from Socially-Emotionally Depriving Institutions. ADOPTION QUARTERLY 2015; 19:44-62. [PMID: 27087772 PMCID: PMC4830636 DOI: 10.1080/10926755.2015.1088106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This study assessed social skills in post-institutionalized (PI) children with respect to age-at-adoption, age-at-assessment, and gender. Parent ratings of social skills (Social Skills Rating System) and behavior problems (Child Behavior Checklist) were obtained for 214 children and 127 adolescents who were adopted from socially-emotionally depriving Russian institutions. Results showed that children adopted before 18 months of age have better social skills than those adopted after this age; those assessed in childhood demonstrate better social skills than those assessed in adolescence. PI females, especially later-adopted adolescents, have particularly poor social skills. Children with poor social skills tend to have higher rates of behavior problems.
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Affiliation(s)
- Megan M. Julian
- Doctoral Candidate, Clinical and Developmental Psychology, University of Pittsburgh, Psychology Department, 210 South Bouquet St., 3 Floor, Pittsburgh, PA 15260
| | - Robert B. McCall
- Professor, Department of Psychology, Co-Director, University of Pittsburgh Office of Child Development, 400 N. Lexington St., Pittsburgh, PA 15208
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11
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Berens AE, Nelson CA. The science of early adversity: is there a role for large institutions in the care of vulnerable children? Lancet 2015; 386:388-98. [PMID: 25638660 PMCID: PMC9594997 DOI: 10.1016/s0140-6736(14)61131-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It has been more than 80 years since researchers in child psychiatry first documented developmental delays among children separated from family environments and placed in orphanages or other institutions. Informed by such findings, global conventions, including the 1989 UN Convention on the Rights of the Child, assert a child's right to care within a family-like environment that offers individualised support. Nevertheless, an estimated 8 million children are presently growing up in congregate care institutions. Common reasons for institutionalisation include orphaning, abandonment due to poverty, abuse in families of origin, disability, and mental illness. Although the practice remains widespread, a robust body of scientific work suggests that institutionalisation in early childhood can incur developmental damage across diverse domains. Specific deficits have been documented in areas including physical growth, cognitive function, neurodevelopment, and social-psychological health. Effects seem most pronounced when children have least access to individualised caregiving, and when deprivation coincides with early developmental sensitive periods. Offering hope, early interventions that place institutionalised children into families have afforded substantial recovery. The strength of scientific evidence imparts urgency to efforts to achieve deinstitutionalisation in global child protection sectors, and to intervene early for individual children experiencing deprivation.
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Affiliation(s)
- Anne E Berens
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Charles A Nelson
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA; Harvard Center on the Developing Child, Harvard Graduate School of Education, Cambridge, MA, USA.
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12
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Kumsta R, Kreppner J, Kennedy M, Knights N, Rutter M, Sonuga-Barke E. Psychological Consequences of Early Global Deprivation. EUROPEAN PSYCHOLOGIST 2015. [DOI: 10.1027/1016-9040/a000227] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The English & Romanian Adoptees (ERA) study follows children who spent their first years of life in extremely depriving Romanian institutions before they were adopted by families in the UK. The ERA study constitutes a “natural experiment” that allows the examination of the effects of radical environmental change from a profoundly depriving institutional environment to an adoptive family home. The cohort has been assessed at ages 4, 6, 11, and 15 years, and has provided seminal insights into the effects of early global deprivation. The current paper focuses on the long-term psychological sequelae associated with deprivation experiences. These deprivation-specific problems (DSPs) constitute a striking pattern of behavioral impairments, in its core characterized by deficits in social cognition and behavior, as well as quasi-autistic features, often accompanied by cognitive impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD). Possible moderating influences, including variations in family environment, pre-adoption characteristics, and genetic variation, will be discussed to answer the question why some individuals have prospered while others have struggled. Apart from findings on the moderating effect of variation in genes associated with serotonergic and dopaminergic signaling involving specific phenotypes, heterogeneity in outcome is largely unexplained. The review concludes with an outlook on currently ongoing and future research of the ERA study cohort, which involves the investigation of neurobiological and epigenetic mechanisms as possible mediators of the long-term effects of institutional deprivation.
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Affiliation(s)
- Robert Kumsta
- Department of Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Germany
| | - Jana Kreppner
- Institute for Disorders of Impulse and Attention, Psychology, University of Southampton, UK
| | - Mark Kennedy
- Institute for Disorders of Impulse and Attention, Psychology, University of Southampton, UK
| | - Nicky Knights
- Institute for Disorders of Impulse and Attention, Psychology, University of Southampton, UK
| | - Michael Rutter
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, UK
| | - Edmund Sonuga-Barke
- Institute for Disorders of Impulse and Attention, Psychology, University of Southampton, UK
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
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13
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Doom JR, Georgieff MK, Gunnar MR. Institutional care and iron deficiency increase ADHD symptomology and lower IQ 2.5-5 years post-adoption. Dev Sci 2015; 18:484-94. [PMID: 25070881 PMCID: PMC4309749 DOI: 10.1111/desc.12223] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 06/06/2014] [Indexed: 12/18/2022]
Abstract
Increased ADHD symptomology and lower IQ have been reported in internationally adopted (IA) children compared to non-adopted peers (Hostinar, Stellern, Schaefer, Carlson & Gunnar, 2012; Kreppner, O'Connor & Rutter, 2001). However, it is unclear whether these outcomes are due to institutional deprivation specifically or to co-occurring micronutrient deficiencies that disrupt brain development (Fuglestad, Rao & Georgieff, 2008b). In this study, IA children were compared to children raised in their biological families to examine differences in ADHD symptomology and IQ 2.5-5 years post-adoption and to assess the contributions of iron deficiency (ID) and duration of deprivation to these cognitive outcomes. ADHD symptoms (parent- and experimenter-reported) and IQ were evaluated in 88 IA (M = 62.1 months, SD = 2.4) and 35 non-adopted children (M = 61.4 months, SD = 1.6). IA children were assessed 29-64 months post-adoption (M = 41.9 months, SD = 10.2). ID was assessed during the initial post-adoption medical visit in 69 children, and children were classified into four groups by iron status, ranging from normal to ID anemia (most severe). IA children had greater ADHD symptomology, p < .01, and lower IQ, p = .001, than non-adopted children. Within the IA group, children with more severe ID at adoption had greater ADHD symptomology, r(69) = 0.40, p = .001, and lower IQ, r(68) = -0.28, p < .05. Duration of institutional care was positively correlated with ADHD symptoms, r(86) = .28, p < .01, but not IQ, r(85) = -.08, p = .52. Longitudinal results indicate improvement in IQ from 12 months post-adoption to age 5 for children with greater ID severity at adoption and longer duration of institutional care but no improvement in ADHD symptoms. These results signify continuing effects of early deprivation and ID on ADHD symptoms and IQ years after adoption. A video abstract of this article can be viewed at http://www.youtube.com/watch?v=vUFDAS3DD1c.
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Affiliation(s)
- Jenalee R Doom
- Institute of Child Development, University of Minnesota, USA; Center for Neurobehavioral Development, University of Minnesota, USA
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Brett ZH, Humphreys KL, Fleming AS, Kraemer GW, Drury SS. Using cross-species comparisons and a neurobiological framework to understand early social deprivation effects on behavioral development. Dev Psychopathol 2015; 27:347-67. [PMID: 25997759 PMCID: PMC5299387 DOI: 10.1017/s0954579415000036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Building upon the transactional model of brain development, we explore the impact of early maternal deprivation on neural development and plasticity in three neural systems: hyperactivity/impulsivity, executive function, and hypothalamic-pituitary-adrenal axis functioning across rodent, nonhuman primate, and human studies. Recognizing the complexity of early maternal-infant interactions, we limit our cross-species comparisons to data from rodent models of artificial rearing, nonhuman primate studies of peer rearing, and the relations between these two experimental approaches and human studies of children exposed to the early severe psychosocial deprivation associated with institutional care. In addition to discussing the strengths and limitations of these paradigms, we present the current state of research on the neurobiological impact of early maternal deprivation and the evidence of sensitive periods, noting methodological challenges. Integrating data across preclinical animal models and human studies, we speculate about the underlying biological mechanisms; the differential impact of deprivation due to temporal factors including onset, offset, and duration of the exposure; and the possibility and consequences of reopening of sensitive periods during adolescence.
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15
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Zeanah CH, Gleason MM. Annual research review: Attachment disorders in early childhood--clinical presentation, causes, correlates, and treatment. J Child Psychol Psychiatry 2015; 56:207-22. [PMID: 25359236 PMCID: PMC4342270 DOI: 10.1111/jcpp.12347] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Though noted in the clinical literature for more than 50 years, attachment disorders have been studied systematically only recently. In part because of the ubiquity of attachments in humans, determining when aberrant behavior is best explained as an attachment disorder as opposed to insecure attachment has led to some confusion. In this selective review, we consider the literature on reactive attachment disorder and disinhibited social engagement disorder and describe an emerging consensus about a number of issues, while also noting some areas of controversy and others where we lack clear answers. We include a brief history of the classification of the disorders, as well as measurement issues. We describe their clinical presentation, causes and vulnerability factors, and clinical correlates, including the relation of disorders to secure and insecure attachment classifications. We also review what little is known and what more we need to learn about interventions. METHODS We conducted a literature search using PubMed, PsycINFO, and Cochrane Library databases, using search terms 'reactive attachment disorder,' 'attachment disorder,' 'indiscriminate behavior,' 'indiscriminate friendliness,' 'indiscriminate socially disinhibited reactive attachment disorder,' 'disinhibited social engagement disorder,' and 'disinhibited social behavior.' We also contacted investigators who have published on these topics. FINDINGS A growing literature has assessed behaviors in children who have experienced various types of adverse caregiving environments reflecting signs of putative attachment disorders, though fewer studies have investigated categorically defined attachment disorders. The evidence for two separate disorders is considerable, with reactive attachment disorder indicating children who lack attachments despite the developmental capacity to form them, and disinhibited social engagement disorder indicating children who lack developmentally appropriate reticence with unfamiliar adults and who violate socially sanctioned boundaries. CONCLUSIONS Although many questions remain to be answered, especially regarding appropriate interventions, we know considerably more about attachment disorders than we did only a decade ago.
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Affiliation(s)
- Charles H Zeanah
- Department of Psychiatry and Behavioral Sciences, Institute of Infant and Early Childhood Mental Health, Tulane University School of Medicine, New Orleans, LA, USA
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16
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Deviations from the expectable environment in early childhood and emerging psychopathology. Neuropsychopharmacology 2015; 40:154-70. [PMID: 24998622 PMCID: PMC4262894 DOI: 10.1038/npp.2014.165] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/10/2014] [Accepted: 06/28/2014] [Indexed: 01/17/2023]
Abstract
Current frameworks for understanding the link between early adverse childhood experiences and later negative life outcomes, including psychopathology, focus on the mediating negative impact on brain and biological systems in the developing child resulting broadly from stress and trauma. Although this approach is useful, we argue that the framework could be functionally extended by distinguishing the effects of two different types of abnormal input, both deviations from the expectable environment in early childhood. Specifically, we review the consequences of inadequate input (eg, neglect/deprivation) and harmful input (eg, abuse/trauma) on brain and biological development. We then review evidence on the differential links between each type of abnormal input to four selected domains of psychopathology (indiscriminate social behavior, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and conduct problems), and consider potential mechanisms for inadequate and harmful input to lead to these outcomes. We conclude that the careful consideration of the type of deviation from the expected environment, while acknowledging the practical difficulties in assessing this, is likely to lead to clearer understanding of the mechanism of risk for psychopathology, and that tailored approaches to prevention and intervention may be informed by considering the unique consequences of inadequate and harmful input when experienced in early childhood.
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Baptista J, Belsky J, Marques S, Silva JR, Oliveira P, Mesquita A, Martins C, Soares I. The interactive effect of maltreatment in the family and unstable institutional caregiving in predicting behavior problems in toddlers. CHILD ABUSE & NEGLECT 2014; 38:2072-2079. [PMID: 25459985 DOI: 10.1016/j.chiabu.2014.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 06/04/2023]
Abstract
The current study extends research on the effects of institutionalization, most notably by examining whether-and how-both pre-institutional maltreatment in the family and the stability and consistency of institutional care interact to shape emotional and behavioral development. Fifty Portuguese children, placed in residential institutions when 8 days to 26 months of age, were evaluated using the Child Behavior Checklist when aged 18-31 months. Caregiver-rated internalizing and externalizing behavior problems proved to be unrelated to both early family and institutional experiences, as main effects, but the interaction of these factors significantly predicted externalizing problems: a history of maltreatment in the family coupled with unstable institutional caregiving arrangements predicted especially elevated levels of externalizing problems. Results are discussed in terms of the importance of more distal and proximate developmental experiences.
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Affiliation(s)
| | - Jay Belsky
- University of California, Davis, CA, USA
| | | | | | | | - Ana Mesquita
- School of Psychology, University of Minho, Portugal
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18
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Muhamedrahimov RJ, Agarkova VV, Vershnina EA, Palmov OI, Nikiforova NV, McCall RB, Groark CJ. BEHAVIOR PROBLEMS IN CHILDREN TRANSFERRED FROM A SOCIOEMOTIONALLY DEPRIVING INSTITUTION TO ST. PETERSBURG (RUSSIAN FEDERATION) FAMILIES. Infant Ment Health J 2014; 35:111-22. [DOI: 10.1002/imhj.21435] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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19
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Doom JR, Gunnar MR, Georgieff MK, Kroupina MG, Frenn K, Fuglestad AJ, Carlson SM. Beyond stimulus deprivation: iron deficiency and cognitive deficits in postinstitutionalized children. Child Dev 2014; 85:1805-12. [PMID: 24597672 DOI: 10.1111/cdev.12231] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Children adopted from institutions have been studied as models of the impact of stimulus deprivation on cognitive development (Nelson, Bos, Gunnar, & Sonuga-Barke, 2011), but these children may also suffer from micronutrient deficiencies (Fuglestad et al., 2008). The contributions of iron deficiency (ID) and duration of deprivation on cognitive functioning in children adopted from institutions between 17 and 36 months of age were examined. ID was assessed in 55 children soon after adoption, and cognitive functioning was evaluated 11-14.6 months postadoption when the children averaged 37.4 months old (SD = 4.9). ID at adoption and longer duration of institutional care independently predicted lower IQ scores and executive function (EF) performance. IQ did not mediate the association between ID and EF.
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Affiliation(s)
- Jenalee R Doom
- Institute of Child Development and Center for Neurobehavioral Development, University of Minnesota
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20
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Baptista J, Belsky J, Martins C, Silva J, Marques S, Mesquita A, Soares I. SOCIAL WITHDRAWAL BEHAVIOR IN INSTITUTIONALIZED TODDLERS: INDIVIDUAL, EARLY FAMILY AND INSTITUTIONAL DETERMINANTS. Infant Ment Health J 2013. [DOI: 10.1002/imhj.21416] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jay Belsky
- University of California, Davis, King Abdulaziz University, Saudi Arabia; and Birkbeck University; London
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21
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Julian MM. Age at adoption from institutional care as a window into the lasting effects of early experiences. Clin Child Fam Psychol Rev 2013; 16:101-45. [PMID: 23576122 PMCID: PMC3739479 DOI: 10.1007/s10567-013-0130-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
One of the major questions of human development is how early experience impacts the course of development years later. Children adopted from institutional care experience varying levels of deprivation in their early life followed by qualitatively better care in an adoptive home, providing a unique opportunity to study the lasting effects of early deprivation and its timing. The effects of age at adoption from institutional care are discussed for multiple domains of social and behavioral development within the context of several prominent developmental hypotheses about the effects of early deprivation (cumulative effects, experience-expectant developmental programming, and experience-adaptive developmental programming). Age at adoption effects are detected in a majority of studies, particularly when children experienced global deprivation and were assessed in adolescence. For most outcomes, institutionalization beyond a certain age is associated with a step-like increase in risk for lasting social and behavioral problems, with the step occurring at an earlier age for children who experienced more severe levels of deprivation. Findings are discussed in terms of their concordance and discordance with our current hypotheses, and speculative explanations for the findings are offered.
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Affiliation(s)
- Megan M Julian
- Office of Child Development, University of Pittsburgh, 400 N. Lexington Ave., Pittsburgh, PA 15208, USA.
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22
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Rutter M, Kumsta R, Schlotz W, Sonuga-Barke E. Longitudinal studies using a "natural experiment" design: the case of adoptees from Romanian institutions. J Am Acad Child Adolesc Psychiatry 2012; 51:762-70. [PMID: 22840547 DOI: 10.1016/j.jaac.2012.05.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/19/2012] [Accepted: 05/22/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To summarize the advantages and limitations of general population, high-risk and "natural experiment" longitudinal studies for studying psychological change. The English and Romanian Adoptees study is used as an example of a "natural experiment," and detailed findings are provided. METHOD What is new is a focus on the young people who spent the whole of their life in institutional care up to the time of adoption and who did not show subnutrition. The results were compared with a composite comparison group who had not experienced institutional care or who were adopted before the age of 6 months. The outcomes were assessed in terms of previously established deprivation-specific patterns (DSPs). RESULTS "Pure" psychosocial deprivation was associated with a substantial increase in the rate of DSPs. It was not associated with significantly impaired head growth if institutional care lasted less than 6 months, whereas thereafter there was a 2.5 standard deviation reduction. Subnutrition differed in being accompanied by impaired head and body growth even with institutional care lasting less than 6 months. In the pure psychosocial deprivation group, 45.5% showed a DSP at 15 years compared with 1.3% in the comparison group. CONCLUSION "Pure" psychosocial deprivation (in the absence of subnutrition) had a profound effect on psychological functioning in the form of DSPs. Subnutrition had a surprisingly small effect on DSPs.
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Affiliation(s)
- Michael Rutter
- Medical Research Council Social, Genetic, and Developmental Psychiatry Centre, King's College London
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23
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Mi Ok kim, 박현정. An Exploratory Study on Life Experiences of Youth with Intellectual Disabilities in Residential Facilities. ACTA ACUST UNITED AC 2012. [DOI: 10.20970/kasw.2012.64.2.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Juffer F, Palacios J, Le Mare L, Sonuga-Barke EJS, Tieman W, Bakermans-Kranenburg MJ, Vorria P, van IJzendoorn MH, Verhulst FC. II. DEVELOPMENT OF ADOPTED CHILDREN WITH HISTORIES OF EARLY ADVERSITY. Monogr Soc Res Child Dev 2011. [DOI: 10.1111/j.1540-5834.2011.00627.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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van IJzendoorn MH, Palacios J, Sonuga-Barke EJS, Gunnar MR, Vorria P, McCall RB, LeMare L, Bakermans-Kranenburg MJ, Dobrova-Krol NA, Juffer F. Children in Institutional Care: Delayed Development and Resilience. Monogr Soc Res Child Dev 2011; 76:8-30. [PMID: 25125707 DOI: 10.1111/j.1540-5834.2011.00626.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Children exposed to institutional care often suffer from "structural neglect" which may include minimum physical resources, unfavorable and unstable staffing patterns, and social-emotionally inadequate caregiver-child interactions. This chapter is devoted to the analysis of the ill effects of early institutional experiences on resident children's development. Delays in the important areas of physical, hormonal, cognitive, and emotional development are discussed. The evidence for and against the existence of a distinctive set of co-occurring developmental problems in institutionalized children is weighed and found to not yet convincingly demonstrate a "post-institutional syndrome". Finally, shared and non-shared features of the institutional environment and specific genetic, temperamental, and physical characteristics of the individual child are examined that might make a crucial difference in whether early institutional rearing leaves irreversible scars.
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26
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Nelson CA, Bos K, Gunnar MR, Sonuga-Barke EJS. The Neurobiological Toll of Early Human Deprivation. Monogr Soc Res Child Dev 2011; 76:127-146. [PMID: 25018565 DOI: 10.1111/j.1540-5834.2011.00630.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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27
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Growth delay as an index of allostatic load in young children: predictions to disinhibited social approach and diurnal cortisol activity. Dev Psychopathol 2011; 23:859-71. [PMID: 21756437 DOI: 10.1017/s0954579411000356] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The goal of this study was to examine whether growth delay can serve as an index of allostatic load during early development, as it is well known that the activity of stress-mediating systems inhibits growth. The participants were children adopted internationally from institutional care (n = 36), children adopted internationally from foster care (n = 26), and nonadopted children (n = 35). For the adopted children, height for age and weight for height were assessed at adoption; for all children, disinhibited social approach (DSA; termed elsewhere as "indiscriminate friendliness") and diurnal cortisol were assessed at 6-8 years (M = 6.9 years). For internationally adopted children in general, and postinstitutionalized children specifically, linear growth delay assessed at the time of adoption was associated with more dysregulated behavior in response to an unfamiliar adult (i.e., greater DSA) and a more dysregulated diurnal cortisol rhythm (i.e., higher late afternoon and evening values). Further, among the most growth-delayed children, higher cortisol levels later in the day were correlated with DSA. The potential for using growth delay as an allostatic load indicator and the possible problems and limitations in its use in child populations are discussed.
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Abstract
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.
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van IJzendoorn MH, Palacios J, Sonuga-Barke EJS, Gunnar MR, Vorria P, McCall RB, LeMare L, Bakermans-Kranenburg MJ, Dobrova-Krol NA, Juffer F. Children in Institutional Care: Delayed Development and Resilience. Monogr Soc Res Child Dev 2011. [PMID: 25125707 DOI: 10.1111/j.1540–5834.2011.00626.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children exposed to institutional care often suffer from "structural neglect" which may include minimum physical resources, unfavorable and unstable staffing patterns, and social-emotionally inadequate caregiver-child interactions. This chapter is devoted to the analysis of the ill effects of early institutional experiences on resident children's development. Delays in the important areas of physical, hormonal, cognitive, and emotional development are discussed. The evidence for and against the existence of a distinctive set of co-occurring developmental problems in institutionalized children is weighed and found to not yet convincingly demonstrate a "post-institutional syndrome". Finally, shared and non-shared features of the institutional environment and specific genetic, temperamental, and physical characteristics of the individual child are examined that might make a crucial difference in whether early institutional rearing leaves irreversible scars.
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Abstract
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.
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31
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Fujisawa KK, Ozaki K, Suzuki K, Yamagata S, Kawahashi I, Ando J. Genetic and environmental relationships between head circumference growth in the first year of life and sociocognitive development in the second year: a longitudinal twin study. Dev Sci 2011; 15:99-112. [DOI: 10.1111/j.1467-7687.2011.01097.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Muñoz-Hoyos A, Molina-Carballo A, Augustin-Morales M, Contreras-Chova F, Naranjo-Gómez A, Justicia-Martínez F, Uberos J. Psychosocial dwarfism: psychopathological aspects and putative neuroendocrine markers. Psychiatry Res 2011; 188:96-101. [PMID: 21071098 DOI: 10.1016/j.psychres.2010.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 09/04/2010] [Accepted: 10/05/2010] [Indexed: 02/08/2023]
Abstract
There exists an extensive terminology for defining the situation of children who, in varying circumstances, suffer from affective deprivation (AD), within an unsatisfactory family situation or in institutions. Nevertheless, the neuroendocrine mechanisms (if they exist) determining it have yet to be identified. Our objective was to determine if specific neuroendocrine markers, all of them previously implicated in affective disorders, could be modified, and in which sense, in affective deprivation syndrome of the child. For this purpose, we studied three separate groups of children: (1) control group (CG); (2) children suffering from AD; and (3) children with non-organic failure to thrive (NOFT). In every case, we studied the serum levels of melatonin, serotonin, β-endorphins and adrenocorticotropic hormone (ACTH); and kynurenine pathway tryptophan metabolites (both during the day and at night). Significantly, there was a conspicuous reduction in the levels of each of the neuroendocrine markers (melatonin, serotonin, β-endorphins and ACTH) in the group suffering from affective deficiency, a diminution which was even more noticeable in the group of patients presenting delayed growth. Furthermore, as also occurs in other affective disorders, there were corresponding modifications in the metabolisation of tryptophan. We report the existence of neuroendocrine mechanisms that are associated with the above-mentioned clinical manifestations in these patients, mechanisms that may underlie the close connection existing between AD syndrome and the cause of NOFT. These data suggest that the AD syndrome and NOFT comprise a single process, but one with a different evolutionary continuum of psychosocial dwarfism.
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Affiliation(s)
- Antonio Muñoz-Hoyos
- Unidad de Gestion Clinica de Pediatria, Hospital Universitario San Cecilio, Universidad de Granada, Spain
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Palacios J, Román M, Camacho C. Growth and development in internationally adopted children: extent and timing of recovery after early adversity. Child Care Health Dev 2011; 37:282-8. [PMID: 20666780 DOI: 10.1111/j.1365-2214.2010.01142.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Following initial adversity, internationally adopted children arrive with significant growth and developmental delays. Post-placement recovery has been widely documented, but little has been known about its extent and timing several years after placement and in children with diverse pre-adoptive experiences. METHODS A total of 289 children adopted from six countries into Spanish families were studied. Growth and psychological development were considered on arrival and after an average of over 3 years. RESULTS Growth and developmental initial delays affected a substantial percentage of the children. Post-adoption recovery seemed quicker and more complete in weight and height than in head circumference and psychological development. Initial and later values were correlated, but growth-development relation on arrival subsequently lost significance. Most of the catch-up happened in the first three post-adoption years. CONCLUSION Adoption offers an impressive opportunity for recovery after previous adversity, although continuity between past and present persists. The improvement is more marked in some areas than in others and more substantial in the first post-adoption years.
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Affiliation(s)
- Jesús Palacios
- Faculty of Psychology, Department of Developmental Psychology, University of Sevilla, Sevilla, Spain.
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34
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Jaffee SR, Maikovich-Fong AK. Effects of chronic maltreatment and maltreatment timing on children's behavior and cognitive abilities. J Child Psychol Psychiatry 2011; 52:184-94. [PMID: 20735512 PMCID: PMC2998571 DOI: 10.1111/j.1469-7610.2010.02304.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Chronic maltreatment has been associated with the poorest developmental outcomes, but its effects may depend on the age when the maltreatment began, or be confounded by co-occurring psychosocial risk factors. METHOD We used data from the National Survey of Child and Adolescent Well-Being (NSCAW) to identify four groups of children who varied in the timing, extent, and continuity of their maltreatment from birth to 9 years. Internalizing and externalizing problems, prosocial behavior, and IQ were assessed 21 months, on average, following the most recent maltreatment report. RESULTS Children maltreated in multiple developmental periods had more externalizing and internalizing problems and lower IQ scores than children maltreated in only one developmental period. Chronically maltreated children had significantly more family risk factors than children maltreated in one developmental period and these accounted for maltreatment chronicity effects on externalizing and internalizing problems, but not IQ. The timing of maltreatment did not have a unique effect on cognitive or behavioral outcomes, although it did moderate the effect of maltreatment chronicity on prosocial behavior. CONCLUSION There is a need for early intervention to prevent maltreatment from emerging and to provide more mental health and substance use services to caregivers involved with child welfare services.
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Affiliation(s)
- Sara R Jaffee
- Institute of Psychiatry, King's College London, London, UK.
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Mehta MA, Gore-Langton E, Golembo N, Colvert E, Williams SCR, Sonuga-Barke E. Hyporesponsive Reward Anticipation in the Basal Ganglia following Severe Institutional Deprivation Early in Life. J Cogn Neurosci 2010; 22:2316-25. [DOI: 10.1162/jocn.2009.21394] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
Severe deprivation in the first few years of life is associated with multiple difficulties in cognition and behavior. However, the brain basis for these difficulties is poorly understood. Structural and functional neuroimaging studies have implicated limbic system structures as dysfunctional, and one functional imaging study in a heterogeneous group of maltreated individuals has confirmed the presence of abnormalities in the basal ganglia. Based on these studies and known dopaminergic abnormalities from studies in experimental animals using social isolation, we used a task of monetary reward anticipation to examine the functional integrity of brain regions previously shown to be implicated in reward processing. Our sample included a group of adolescents (n = 12) who had experienced global deprivation early in their lives in Romania prior to adoption into UK families. In contrast to a nonadopted comparison group (n = 11), the adoptees did not recruit the striatum during reward anticipation despite comparable performance accuracy and latency. These results show, for the first time, an association between early institutional deprivation and brain reward systems in humans and highlight potential neural vulnerabilities resulting from such exposures.
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Affiliation(s)
| | | | | | | | | | - Edmund Sonuga-Barke
- 1King's College London, UK
- 2University of Southampton, UK
- 3University of Ghent, Belgium
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Kumsta R, Kreppner J, Rutter M, Beckett C, Castle J, Stevens S, Sonuga-Barke EJ. III. Deprivation-specific psychological patterns. Monogr Soc Res Child Dev 2010; 75:48-78. [PMID: 20500633 DOI: 10.1111/j.1540-5834.2010.00550.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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King C, Davis T. Nutritional treatment of infants and children with faltering growth. Eur J Clin Nutr 2010; 64 Suppl 1:S11-3. [PMID: 20442718 DOI: 10.1038/ejcn.2010.41] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C King
- Imperial Health Care, Hammersmith Hospital, London W12 OHS, UK. mail:
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Merz EC, McCall RB. Behavior problems in children adopted from psychosocially depriving institutions. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2010; 38:459-70. [PMID: 20084451 PMCID: PMC2892211 DOI: 10.1007/s10802-009-9383-4] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Behavior problems were investigated in 342 6- to 18-year-old children adopted from psychosocially depriving Russian institutions that provided adequate physical resources but not consistent, responsive caregiving. Results indicated that attention and externalizing problems were the most prevalent types of behavior problems in the sample as a whole. Behavior problem rates increased with age at adoption, such that children adopted at 18 months or older had higher rates than never-institutionalized children but younger-adopted children did not. There was a stronger association between age at adoption and behavior problems during adolescence than at younger ages at assessment. Children adopted from psychosocially depriving institutions had lower behavior problem rates than children adopted from severely depriving Romanian institutions in the 1990s. The implications of these results are that early psychosocial deprivation is associated with behavior problems, children exposed to prolonged early deprivation may be especially vulnerable to the developmental stresses of adolescence, and severe institutional deprivation is associated with a higher percentage of behavior problems after a shorter duration of exposure.
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Affiliation(s)
- Emily C Merz
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Sonuga-Barke EJS, Halperin JM. Developmental phenotypes and causal pathways in attention deficit/hyperactivity disorder: potential targets for early intervention? J Child Psychol Psychiatry 2010; 51:368-89. [PMID: 20015192 DOI: 10.1111/j.1469-7610.2009.02195.x] [Citation(s) in RCA: 214] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Early intervention approaches have rarely been implemented for the prevention of attention deficit/hyperactivity disorder (ADHD). In this paper we explore whether such an approach may represent an important new direction for therapeutic innovation. We propose that such an approach is most likely to be of value when grounded in and informed by developmental models of the dynamic, complex and heterogeneous nature of the condition. First, we set out a rationale for early intervention grounded in the science of ADHD viewed through developmental models. Second, we re-examine the concept of disorder-onset from the perspective of developmental trajectories and phenotypes. Third, we examine potential causal pathways to ADHD with regard to originating risk, pathophysiological mediators, environmental moderators and developmental continuities. Finally, we explore the potential value of strategies for identifying young children at risk for ADHD, and implementing interventions in ways that can target these underlying pathogenic processes. The utility of such an approach represents an important area for future research but still requires 'proof of concept'. Therefore prior to widespread clinical implementation, far greater knowledge is required of (i) developmental pathways into ADHD, (ii) the value of identifying neuropsychological mediators of these pathways, and (iii) the extent to which targeting mediating mechanisms will improve treatment outcomes for children with ADHD.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, SO17 1BJ, UK
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Sonuga-Barke EJ, Schlotz W, Rutter M. VII. PHYSICAL GROWTH AND MATURATION FOLLOWING EARLY SEVERE INSTITUTIONAL DEPRIVATION: DO THEY MEDIATE SPECIFIC PSYCHOPATHOLOGICAL EFFECTS? Monogr Soc Res Child Dev 2010; 75:143-66. [DOI: 10.1111/j.1540-5834.2010.00554.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rutter M, Sonuga-Barke EJ, Castle J. I. INVESTIGATING THE IMPACT OF EARLY INSTITUTIONAL DEPRIVATION ON DEVELOPMENT: BACKGROUND AND RESEARCH STRATEGY OF THE ENGLISH AND ROMANIAN ADOPTEES (ERA) STUDY. Monogr Soc Res Child Dev 2010; 75:1-20. [DOI: 10.1111/j.1540-5834.2010.00548.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mehta MA, Golembo NI, Nosarti C, Colvert E, Mota A, Williams SCR, Rutter M, Sonuga-Barke EJS. Amygdala, hippocampal and corpus callosum size following severe early institutional deprivation: the English and Romanian Adoptees study pilot. J Child Psychol Psychiatry 2009; 50:943-51. [PMID: 19457047 DOI: 10.1111/j.1469-7610.2009.02084.x] [Citation(s) in RCA: 304] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The adoption into the UK of children who have been reared in severely deprived conditions provides an opportunity to study possible association between very early negative experiences and subsequent brain development. This cross-sectional study was a pilot for a planned larger study quantifying the effects of early deprivation on later brain structure. We used magnetic resonance imaging (MRI) to measure the sizes of three key brain regions hypothesized to be sensitive to early adverse experiences. Our sample was a group of adoptee adolescents (N = 14) who had experienced severe early institutional deprivation in Romania and a group of non-institutionalised controls (N = 11). The total grey and white matter volumes were significantly smaller in the institutionalised group compared with a group of non-deprived, non-adopted UK controls. After correcting for difference in brain volume, the institutionalised group had greater amygdala volumes, especially on the right, but no differences were observed in hippocampal volume or corpus callosum mid-sagittal area. The left amygdala volume was also related to the time spent in institutions, with those experiencing longer periods of deprivation having a smaller left amygdala volume. These pilot findings highlight the need for future studies to confirm the sensitivity of the amygdala to early deprivation.
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Affiliation(s)
- Mitul A Mehta
- Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, UK
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Govindan RM, Behen ME, Helder E, Makki MI, Chugani HT. Altered water diffusivity in cortical association tracts in children with early deprivation identified with Tract-Based Spatial Statistics (TBSS). Cereb Cortex 2009; 20:561-9. [PMID: 19546156 DOI: 10.1093/cercor/bhp122] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Institutional rearing is associated with neurocognitive and behavioral difficulties. Although such difficulties are thought to reflect abnormal neurologic development resulting from early social deprivation (ED) and there is evidence for functional abnormality in children with histories of ED, the impact of early deprivation on brain anatomy has received little study in humans. The present study utilized an objective and sensitive neuroimaging analysis technique (Tract-Based Spatial Statistics) to evaluate white matter fractional anisotropy (FA) and diffusivity in a group of right-handed children with histories of ED (n = 17; mean age = 10.9 + 2.6 years) as compared with age-matched healthy controls (n = 15; mean age = 11.7 + or - 2.8 years). Participants underwent magnetic resonance imaging diffusion tensor imaging sequences and comprehensive neuropsychological evaluations. Results revealed reduced FA in frontal, temporal, and parietal white matter including components of uncinate and superior longitudinal fasciculi, in children with histories of ED, providing further support for limbic and paralimbic abnormalities in children with such histories. Furthermore, white matter abnormalities were associated with duration of time in the orphanage and with inattention and hyperactivity scores. It is suspected that the observed white matter abnormalities are associated with multiple depriving factors (e.g., poor prenatal care, postnatal stress) associated with institutional caregiving.
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Affiliation(s)
- Rajkumar Munian Govindan
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, School of Medicine, Detroit, MI 48201, USA
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Marshall PJ, Kenney JW. Biological perspectives on the effects of early psychosocial experience. DEVELOPMENTAL REVIEW 2009. [DOI: 10.1016/j.dr.2009.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Gene-environment interaction (G x E) has been treated as both a statistical phenomenon and a biological reality. It is argued that, although there are important statistical issues that need to be considered, the focus has to be on the biological implications of G x E. Four reports of G x E deriving from the Dunedin longitudinal study are used as exemplars of the biological considerations that should lead to an hypothesis-driven choice of the specific genetic polymorphisms and the specific environmental influence to be investigated. The same four studies are used to discuss how the assessment of internal and external validity can be undertaken and how experimental approaches in humans and with animal models may be informative in the elucidation of the relevant operative biological mechanisms.
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