IV. Growth Failure in Institutionalized Children

Lingering Effects of Early Institutional Rearing and Cytomegalovirus Infection on the Natural Killer Cell Repertoire of Adopted Adolescents

Adversity during infancy can affect neurobehavioral development and perturb the maturation of physiological systems. Dysregulated immune and inflammatory responses contribute to many of the later effects on health. Whether normalization can occur following a transition to more nurturing, benevolent conditions is unclear. To assess the potential for recovery, blood samples were obtained from 45 adolescents adopted by supportive families after impoverished infancies in institutional settings (post-institutionalized, PI). Their immune profiles were compared to 39 age-matched controls raised by their biological parents (non-adopted, NA). Leukocytes were immunophenotyped, and this analysis focuses on natural killer (NK) cell populations in circulation. Cytomegalovirus (CMV) seropositivity was evaluated to determine if early infection contributed to the impact of an atypical rearing. Associations with tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ), two cytokines released by activated NK cells, were examined. Compared to the NA controls, PI adolescents had a lower percent of CD56bright NK cells in circulation, higher TNF-α levels, and were more likely to be infected with CMV. PI adolescents who were latent carriers of CMV expressed NKG2C and CD57 surface markers on more NK cells, including CD56dim lineages. The NK cell repertoire revealed lingering immune effects of early rearing while still maintaining an overall integrity and resilience.

Mothers' prenatal distress accelerates adrenal pubertal development in daughters

Human life history schedules vary, partly, because of adaptive, plastic responses to early-life conditions. Little is known about how prenatal conditions relate to puberty timing. We hypothesized that fetal exposure to adversity may induce an adaptive response in offspring maturational tempo. In a longitudinal study of 253 mother-child dyads followed for 15 years, we investigated if fetal exposure to maternal psychological distress related to children's adrenarche and gonadarche schedules, assessed by maternal and child report and by dehydroepiandrosterone sulfate (DHEA-S), testosterone, and estradiol levels. We found fetal exposure to elevated maternal prenatal psychological distress predicted earlier adrenarche and higher DHEA-S levels in girls, especially first-born girls, and that associations remained after covarying indices of postnatal adversity. No associations were observed for boys or for gonadarche in girls. Adrenarche orchestrates the social-behavioral transition from juvenility to adulthood; therefore, significant findings for adrenarche, but not gonadarche, suggest that prenatal maternal distress instigates an adaptive strategy in which daughters have earlier social-behavioral maturation. The stronger effect in first-borns suggests that, in adverse conditions, it is in the mother's adaptive interest for her daughter to hasten social maturation, but not necessarily sexual maturation, because it would prolong the duration of the daughter allomothering younger siblings. We postulate a novel evolutionary framework that human mothers may calibrate the timing of first-born daughters' maturation in a way that optimizes their own reproductive success.

The long-lasting effect of early life family structure on social position, well-being, and biological condition in adulthood

BACKGROUND

The absence of even one parent has short- and long-term effects on the child's current and future health. The purpose of the study was to determine whether there is a long-term relationship between the type of family in which men were raised and an individual's adult social position, well-being in adulthood and their biological condition regardless of social status in adulthood.

MATERIALS AND METHODS

Data for 4528 males, aged 25-80 years, were selected from the archives of the Lower Silesian Medical Centre in Wrocław, Poland. A total of 329 men declared that they grew up in incomplete families. Height, weight, % fat, cardiovascular and respiratory systems, blood parameters, and health of men who grew up in complete or incomplete families were compared.

RESULTS

Growing up in an incomplete family reduced chances for better education, decreased life satisfaction in adulthood, and negatively affected the final height. After taking into account the education achieved, the effect persisted only for diastolic blood pressure, creatinine, and serum phosphorus levels.

CONCLUSIONS

Growing up in an incomplete family has a significant impact on male's socioeconomic position (SES), life satisfaction, and final height. A poorer quality of diet is proposed as an early life risk factor for adult health.

Health of Post-Institutionalized Haitian Children Adopted to the United States

OBJECTIVES

Haiti remains a principal placement country for intercountry adoptees to the United States. This project reports the health status of children adopted from Haiti arriving to the U.S. and compares them to intercountry adoptees from other regions.

METHODS

A retrospective chart review was conducted of adoptees placed in the U.S. from Haiti (n=87), age and sex matched with intercountry adoptees placed in the U.S. from Asia (n=87) and Latin America (n=87) between January 2010 and November 2019. Data on immunization status, contagious diseases, and nutrition and growth were analyzed via linear, logistic, and multinomial regression.

RESULTS

After adjusting for age, sex, and standardized height, children adopted from Haiti, compared to adoptees from Latin America and Asia, demonstrated a lack of immunity to hepatitis B (OR=5.89;6.87), increased immunity to hepatitis A (OR=0.38;0.30), infection by two or more parasites (OR=8.43;38.48), high lead levels (OR=23.79;7.04), and anemia (OR=15.25;9.18). Unexpectedly, children adopted from Haiti had greater standardized height (-1.28 vs. -1.82 and -2.13) and standardized weight (-0.32 vs. -0.57 and -1.57) than their counterparts from Latin America and Asia.

CONCLUSIONS

Children adopted from Haiti face complex medical challenges undoubtedly related to the country's low socioeconomic status (SES) and the impact of recurrent natural disasters and governmental neglect on public health infrastructure. Appropriate care is critical in preventing and avoiding transmission of infectious diseases in adoptees and family members. The high incidence of anemia and elevated lead levels may further exacerbate the developmental effects of early institutional deprivation.

Does rapid rebound height growth come at a neurocognitive cost for previously institutionalized youth?

BACKGROUND

Height growth faltering is associated with less optimal behavioral outcomes and educational achievement. Although catch-up growth after growth delay may result in developmental gains, it may also present as a double-edged sword, with consequences for neurocognitive functioning such as symptoms of inattention and hyperactivity. As previously institutionalized (PI) children experience height delays at adoption and catch-up growth after adoption, they provide a cohort to test associations between catch-up growth and attention deficit hyperactivity disorder (ADHD) symptoms.

METHODS

This study used latent growth curve modeling to examine how catch-up in height-for-age growth is related to attention problems in a population of PI youth followed from adoption in infancy through kindergarten. Participants were assessed within three months of arrival into their families (age at entry: 18-36 months). Anthropometrics were measured four times, approximately 7 months apart. Two visits measured behavioral outcomes with parent and teacher reports of ADHD, internalizing, and externalizing symptoms at age 5 and kindergarten.

RESULTS

The slope of growth in height z-scores, but not the intercept, was positively associated with parent- and teacher-reported ADHD symptoms in children. A one standard deviation increase in the slope of height z-scores across four assessments was associated with a 0.252 standard deviation increase in ADHD symptoms after controlling for internalizing and externalizing problems, iron status, duration of institutional care, sex, and age. The slope of growth was also associated with internalizing but not externalizing symptoms.

CONCLUSIONS

This study demonstrates that PI children exhibit individual trajectories of height growth postadoption. Higher rates of change in height-for-age growth were associated with increased ADHD symptoms. These results suggest that catch-up growth comes 'at the cost' of poor attention regulation and hyperactive behavior.

Feeding practices of children within institution‐based care: A retrospective analysis of surveillance data

There is limited information on the feeding practices of 9.42 million children living within institution‐based care (IBC) worldwide. Poor feeding practices can predispose or exacerbate malnutrition, illness and disability. Here we describe the feeding practices of children living within IBC based on a retrospective analysis of records from 3335 children, 0–18 years old, participating in Holt International's Child Nutrition Program (CNP), from 36 sites in six countries. Data analysed included demographic information on age, sex, feeding practices, disabilities and feeding difficulties. Descriptive statistics were produced. A generalised linear model explored associations between feeding difficulties and disability and 2 × 2 tables examined feeding difficulties over time. An additional set of feeding observations with qualitative and quantitative data was analysed. At baseline, the median age of children was 16 months (0.66–68 months) with 1650/3335 (49.5%) females. There were 757/3335 (22.7%) children with disabilities; 550/984 (55.9%) were low birth weight; 311/784 (39.7%) were premature; 447/3113 (14.4%) had low body mass index and 378/3335 (11.3%) had feeding difficulties. The adjusted risk of having a feeding difficulty was 5.08 ([95% confidence interval: 2.65–9.7], p ≤ 0.001) times greater in children with disabilities than those without. Many children saw their feeding difficulties resolve after 1‐year in CNP, 54/163 (33.1%) for children with disabilities and 57/106 (53.8%) for those without disabilities. Suboptimal hygiene, dietary and feeding practices were reported. In conclusion, feeding difficulties were common in IBC, especially among children with disabilities. Supporting safe interactive mealtimes for children living within IBC should be prioritised, to ensure overall health and development.

Feeding difficulties are common among children living in institution‐based care (IBC), particularly but not exclusively among those children with disabilities.

Suboptimal feeding practices were common in IBC and encompassed inadequate hygiene, limited support for self‐feeding, reading children's feeding cues (especially around pacing and satiety), addressing feeding difficulties, such as difficulty chewing or swallowing. These should be prioritised in training and supervision for caregivers.

Addressing the needs of this vulnerable group should include support for safe feeding techniques. These should be prioritised to help ease the transition into eventual family‐based care if we are to move towards deinstitutionalizing children and strengthening families.

The role of the amygdala in processing social and affective touch

The amygdala plays a central role in emotion and social behavior, yet its role in processing social and affective touch is not well established. Longitudinal studies reveal that touch-deprived infants show later in life exaggerated emotional reactivity related to structural and functional changes in the amygdala and other brain structures. The internal organization and connectivity of the amygdala is well-suited to process the sensory features of tactile stimuli and also the socio-cognitive dimensions of the received touch. The convergent processing of bottom-up and top-down pathways that carry information about touch results in the elaboration of context appropriate autonomic responses. Indeed, the positive value of affective touch in humans and social grooming in non-human primates is correlated with vagal tone and the release of oxytocin and endogenous opioids. Grooming, the non-human primate equivalent of affective touch in humans, reduces vigilance, that depends on the amygdala. During touch-induced vagal tone and low vigilance, neural activity in the amygdala is substantially different from activity corresponding to the attentive processing of tactile stimuli. Under these circumstances neurons no longer respond phasically to each touch stimulus, rather they signal a sustained functional state in which the amygdala appears decoupled from monitoring the external environment.

Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring

Objectives

The aim of this study is to fill a key information gap on the nutrition-related epidemiology of orphaned and vulnerable children living within institution-based care (IBC) across six countries.

Design

A retrospective analysis with Shewhart control charts and funnel plots to explore intersite and over time variations in nutritional status.

Setting

We conducted a retrospective analysis of records from Holt International’s Child Nutrition Programme from 35 sites in six countries; Mongolia, India, Ethiopia, Vietnam, China and the Philippines.

Participants

Deidentified health records from Holt International’s online nutrition screening database included records from 2926 children, 0–18 years old. Data were collected from 2013 to 2020 and included demographic and health information.

Results

At initial screening, 717 (28.7%) children were anaemic, 788 (34.1%) underweight, 1048 (37.3%) stunted, 212 (12.6%) wasted, 135 (12%) overweight or obese and 339 (31%) had small head circumference. Many had underlying conditions: low birth weight, 514 (57.5%); prematurity, 294 (42.2%) and disabilities, 739 (25.3%). Children with disabilities had higher prevalence of malnutrition compared with counterparts without disabilities at baseline and 1-year screenings. There was marked intersite variation. Funnel plots highlight sites with malnutrition prevalence outside expected limits for this specific population taking into consideration natural variation at baseline and at 1 year. Control charts show changes in site mean z-scores over time in relation to site control limits.

Conclusions

Malnutrition is prevalent among children living within IBC, notably different forms of undernutrition (stunting, underweight, wasting). Underlying risk factors are also common: prematurity, low birth weight and disability. Nutrition interventions should take into account the needs of this vulnerable population, especially for infants and those with disabilities. Using control charts to present data could be especially useful to programme managers as sites outside control limits could represent: problems to be investigated; good practices to be shared.

Anthropometrics of Estonian children in relation to family disruption: Thrifty phenotype and Trivers-Willard effects

Background and objectives

The thrifty phenotype hypothesis proposes that at resource limitation, the growth of some organs/tissues is selectively spared to preserve more critical ones, such as the brain or lungs. The Trivers–Willard hypothesis (TWH) predicts that boys are more vulnerable in the case of resource limitation than girls. Both hypotheses were tested in children from disrupted families, differing in the extent of deprivation/adversities imposed on them.

Methodology

In a retrospective cohort study in the mid-20th century Estonia (Juhan Aul’s database), different types of orphans and children of divorced parents (treatment groups; n = 106–1401) were compared with children from bi-parental families (control groups; n = 2548–8648) so that children from treatment groups were matched with control children on the basis of sex, age, year of birth, urban versus rural origin and socioeconomic position.

Results

Children in orphanages suffered strong growth suppression, best explained by psychosocial deprivation. Their feet were on average 0.5 SD shorter than the feet of the controls, followed by height, leg/torso ratio and cranial volume that differed from controls by ca 0.4 SD. Weight difference was 0.2 SD units, while body mass index did not differ from controls. The growth of boys and girls in orphanages was suppressed to the same extent. Boys whose mothers were dead were relatively smaller and less masculine than girls from such families. Fathers’ absence was unrelated to growth suppression. Sons of divorced parents had broader shoulders than boys whose fathers were dead.

Conclusions and implications

Prediction of TWH about the greater vulnerability of male growth may hold under some conditions but not universally. Predictions of the thrifty phenotype hypothesis were partly supported: trunk growth was spared at the expense of leg growth; however, no evidence for brain sparing was found. Comparison of children of divorced versus dead fathers may appear useful for indirect assessment of sexual selection on offspring quality.

Lay Summary: Boys and girls in orphanages suffered similarly strong growth suppression, best explained by psychosocial deprivation. Boys whose mothers were dead were relatively smaller and less masculine than girls from such families. The occurrence of sex-specific associations between family structure and children’s growth depends on the type of family disruption.

Physical contact in parent-infant relationship and its effect on fostering a feeling of safety

The infant-caregiver relationship involves physical contact for feeding, moving, and other cares, and such contact also encourages the infant to form an attachment, an emotional bond with the caregivers. Physical contact always accompanies somatosensory perception, which is detected by mechanosensory neurons and processed in the brain. Physical contact triggers sensorimotor reflexes such as Transport Response in rodent infants, and calm human infants while being carried. Tactile sensation and deep pressure in physical interactions, such as hugging, can function as emotional communication between infant and caregiver, which can alter the behavior and mood of both the infant and caregiver. This review summarizes the findings related to physical contact between the infant and the caregiver in terms of pleasant, noxious, and neutral somatosensation and discusses how somatosensory perceptions foster a feeling of safety that is important for infant's psychosocial development.

Fear, violence, inequality, and stunting in Guatemala

BACKGROUND

Stunting is defined by the public health community as a length- or height-for-age <-2 SD of a growth standard or reference and is claimed to be caused by poor nutrition, repeated infection, and inadequate psychosocial stimulation.

MATERIAL AND METHODS

Stunting is common at all income levels in middle- and low-income countries. At the higher income levels, stunting is unlikely to be caused by nutrient deficiency or infectious disease.

RESULTS

In Guatemala, 17% of <5-year-olds in the highest family income quintile are stunted. Guatemala has a history of violence from armed conflict, current-day social and economic inequalities, government corruption, and threat of kidnapping for the wealthiest families.

DISCUSSION AND CONCLUSION

The high level of persistent violence creates an ecology of fear, an extreme range of inequalities in Social-Economic-Political-Emotional resources, and biosocial stress that inhibits skeletal growth and causes stunting for people of all income levels.

How to interpret IGF-1 and growth hormone stimulation tests

You are seeing an 11-year-old boy in a general paediatric clinic referred with short stature. His height is below the 0.4th centile. The mid-parental height is on 50th centile. Baseline investigations, including renal and liver function, coeliac screen and thyroid function tests are normal. You have a suspicion of growth hormone deficiency. Should you check an insulin-like growth factor-1 level or proceed with a growth hormone provocation test? The current paper will aim to give an overview of these tests and factors to consider when interpreting the results.

Prevalence and number of children living in institutional care: global, regional, and country estimates

BACKGROUND

Children living in institutionalised settings are at risk of negative health and developmental outcomes, as well as physical and emotional abuse, yet information on their numbers is scarce. Therefore, the aim of our study was to estimate global-level, regional-level, and country-level numbers and percentages of children living in institutional care.

METHODS

In this estimation study, we did a systematic review of peer-reviewed publications and a comprehensive review of surveys and unpublished literature to construct a dataset on children living in institutional care from 136 countries between 2001 and 2018. We applied a wide range of methods to estimate the number and percentages of children living in institutional care in 191 countries in 2015, the year the Sustainable Development Goals were adopted. We generated 98 sets of estimates for each dataset, with possible combinations of imputation methods for countries with different available data points. Of these 98 sets, we report here five types of global-level estimates: estimates with the highest values, those with the lowest values, those with median values, those with uncertainty levels, and those derived from methods with the smallest root-mean-square errors (RMSE).

FINDINGS

Global estimates of children living in institutions in 2015 was highly sensitive to the methods and data used, ranging from 3·18 million to 9·42 million children, with a median estimate of 5·37 million. When selecting the method with the lowest RMSE, the global estimate was 4·21 million, whereas with negative binomial regression with bootstrapping, the global estimate was 7·52 (95% CI 7·48-7·56) million. We also observed large variations in country-level estimates. Compared with other regions, estimates in south Asia, sub-Saharan Africa, and Latin America had larger variations in values when switching between estimation methods. High-income countries had the highest average prevalence of institutionalisation, whereas low-income countries had the lowest average prevalence. Estimates from the full data with the smallest RMSE method showed that south Asia had the largest estimated number of children living in institutions (1·13 million), followed by Europe and central Asia (1·01 million), east Asia and Pacific (0·78 million), sub-Saharan Africa (0·65 million), Middle East and North Africa (0·30 million), Latin America and the Caribbean (0·23 million), and North America (0·09 million). North America consistently had the lowest estimates among all regions.

INTERPRETATION

Worldwide, institutional care places millions of children at elevated risk of negative health and developmental outcomes, highlighting the need for deinstitutionalisation. However, there is considerable uncertainty regarding the number of children living in institutions. To improve estimates of the size of this population, we need to standardise the definition of institutional care and improve data collection, particularly in countries with large child populations.

FUNDING

Lumos Foundation.

The nutritional status of children living within institutionalized care: a systematic review

Background

There are an estimated 2.7 million children living within institutionalized care worldwide. This review aimed to evaluate currently available data on the nutrition status of children living within institutionalized care.

Methods

We searched four databases (Pubmed/Medline, CINHAL Plus, Embase and Global Health Database) for relevant articles published from January 1990 to January 2019. Studies that included information on anthropometry or micronutrient status of children living within institutionalized care were eligible for inclusion. The review is registered on PROSPERO: CRD42019117103.

Results

From 3,602 titles screened, we reviewed 98 full texts, of which 25 papers were eligible. Two (8%) studies reported data from multiple countries, nine (36%) were from Asia, four (16%) from Africa, three (12%) from Eastern Europe, four (16%) from the European Union and one (4%) from each of the remaining regions (Middle East, South America and the Caribbean). Twenty-two (88%) were cross sectional. Ten (40%) of the studies focused on children >5 years, seven (28%) on children <5 years, seven (28%) covered a wide age range and one did not include ages. Low birth weight prevalence ranged from 25–39%. Only five (20%) included information on children with disabilities and reported prevalence from 8–75%. Prevalence of undernutrition varied between ages, sites and countries: stunting ranged from 9–72%; wasting from 0–27%; underweight from 7–79%; low BMI from 5–27%. Overweight/obesity ranged from 10–32% and small head circumference from 17–41%. The prevalence of HIV was from 2–23% and anemia from 3–90%. Skin conditions or infections ranged from 10–31% and parasites from 6–76%. Half the studies with dietary information found inadequate intake or diet diversity. Younger children were typically more malnourished than older children, with a few exceptions. Children living within institutions were more malnourished than community peers, although children living in communities were also often below growth standards. High risk of bias was found.

Conclusions

This study highlights the limited amount of evidence-based data available on the nutritional status of children in institutions. Of the studies reviewed, children living within institutionalized care were commonly malnourished, with undernutrition affecting young children particularly. Micronutrient deficiencies and obesity were also prevalent. Data quality was often poor: as well as suboptimal reporting of anthropometry, few looked for or described disabilities, despite disability being common in this population and having a large potential impact on nutrition status. Taken together, these findings suggest a need for greater focus on improving nutrition for younger children in institutions, especially those with disabilities. More information is needed about the nutritional status of the millions of children living within institutionalized care to fully address their right and need for healthy development.

Early Deprivation Revisited: Contemporary Studies of the Impact on Young Children of Institutional Care

There is clear evidence that early deprivation in the form of early institutional care affects children both immediately and long after they are removed from the institution. This article reviews the modern literature on the impact of institutional care from animal models to longitudinal studies in humans. Importantly, we examine the current understanding of neuroendocrine regulation in the context of early deprivation. We discuss the opportunities and limitations of studying the effects of deprivation in previously institutionalized children, review behavioral findings and related neurobiological studies, and address the physical health ramifications of institutional care. Finally, we touch on future directions for both science and intervention.

Development of children adopted to the United States following a social-emotional intervention in St. Petersburg (Russian Federation) institutions

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.

Early Secure Attachment as a Protective Factor Against Later Cognitive Decline and Dementia

The etiology of neurodegenerative disorders such as dementia is complex and incompletely understood. Interest in a developmental perspective to these pathologies is gaining momentum. An early supportive social environment seems to have important implications for social, affective and cognitive abilities across the lifespan. Attachment theory may help to explain the link between these early experiences and later outcomes. This theory considers early interactions between an infant and its caregiver to be crucial to shaping social behavior and emotion regulation strategies throughout adult life. Furthermore, research has demonstrated that such early attachment experiences can, potentially through epigenetic mechanisms, have profound neurobiological and cognitive consequences. Here we discuss how early attachment might influence the development of affective, cognitive, and neurobiological resources that could protect against cognitive decline and dementia. We argue that social relations, both early and late in life, are vital to ensuring cognitive and neurobiological health. The concepts of brain and cognitive reserve are crucial to understanding how environmental factors may impact cognitive decline. We examine the role that attachment might play in fostering brain and cognitive reserve in old age. Finally, we put forward the concept of affective reserve, to more directly frame the socio-affective consequences of early attachment as protectors against cognitive decline. We thereby aim to highlight that, in the study of aging, cognitive decline and dementia, it is crucial to consider the role of affective and social factors such as attachment.

The Consequences of Foster Care Versus Institutional Care in Early Childhood on Adolescent Cardiometabolic and Immune Markers: Results From a Randomized Controlled Trial

OBJECTIVE

Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. We compared the consequences of long-term, high-quality foster care versus standard institution-based care, which began in early childhood on cardiometabolic and immune markers assessed at the time of adolescence.

METHODS

The Bucharest Early Intervention Project is a longitudinal investigation of children institutionalized during early childhood (ages 6 to 30 months at baseline) who were subsequently randomized to either high-quality foster care or continued institutional care. At the age of 16 years, 127 respondents participated in a biomarker collection protocol, including 44 institutionalized children randomly assigned to receive care as usual, 41 institutionalized children randomized to be removed from institutional care and placed in high-quality foster care in infancy, and a control group of 42 demographically matched children raised in biological families. Outcomes included body mass index (BMI), systolic and diastolic blood pressure, C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, glycosylated hemoglobin A1c, and Epstein-Barr virus antibody titers.

RESULTS

Early institutional rearing was not associated with differences in cardiometabolic or immune markers. Randomization to foster care and age of placement into foster care were also unrelated to these markers, with the exception of BMI z-score, where children assigned to care as usual had lower BMI z-scores relative to children assigned to foster care (-0.23 versus 0.08, p = .06), and older age at placement was associated with lower BMI (β = -0.07, p = .03).

CONCLUSIONS

The impact of institutional rearing on measures of cardiometabolic health and immune system functioning is either absent or not evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type.

CLINICAL TRIAL REGISTRATION

NCT00747396.

Caregiving Disruptions Affect Growth and Pubertal Development in Early Adolescence in Institutionalized and Fostered Romanian Children: A Randomized Clinical Trial

OBJECTIVES

To determine the effects of foster care vs institutional care, as well as disruptions in the caregiving environment on physical development through early adolescence.

STUDY DESIGN

This was a randomized controlled trial of 114 institutionalized, though otherwise healthy, children from 6 orphanages and 51 never institutionalized control children living in birth families (family care group) in Bucharest, Romania. Children were followed from baseline (21 months, range 5-31) through age 12 years for caregiving disruptions and growth trajectories and through age 14 years for pubertal development.

RESULTS

Children randomized to the foster care group showed greater rates of growth in height, weight, and body mass index (BMI) through age 12 years than institutionalized group. Tanner development was delayed in institutionalized group boys compared with foster care group and family care group boys at 12 but not 14 years. There were no differences in Tanner development and age of menarche among foster care group, institutionalized group, and family care group girls at ages 12 and 14 years. More disruptions in caregiving between 30 months and 12 years moderated decreases in growth rates of height in foster care group and weight in foster care group and institutionalized group across age. institutionalized group boys with ≥2 disruptions showed lower Tanner scores at age 12 vs institutionalized group and foster care group boys with <2 disruptions. foster care group girls with ≥2 disruptions had higher Tanner scores at age 14 vs foster care group girls with <2 disruptions. Age of menarche was not affected by caregiving disruptions.

CONCLUSIONS

For children who experienced early institutionalization, stable placement within family care is essential to ensuring the best outcomes for physical developmental.

TRIAL REGISTRATION

clinicaltrials.gov: NCT00747396.

Early Life Adversity with Height Stunting Is Associated with Cardiometabolic Risk in Adolescents Independent of Body Mass Index

OBJECTIVE

To evaluate cardiovascular and metabolic function in youths adopted internationally from orphanages/institutions (postinstitutionalized) who were height-stunted at adoption.

STUDY DESIGN

A total of 30 postinstitutionalized youths (age, 9-18 years; body mass index [BMI] percentile, 7.2-90.4) who were height-stunted at adoption were compared with age- and BMI percentile-matched youths (n = 90). Measurements included total body fat and visceral adipose tissue (dual radiograph absorptiometry), arterial stiffness (augmentation index and pulse wave velocity), cardiac autonomic function (heart rate variability), blood pressure, and fasting lipid, glucose, and insulin levels. Linear regression analyses were computed controlling for parent education, age, trunk tissue fat, height-for-age, sex, and race.

RESULTS

Compared with controls of the same age, sex, and BMI, the postinstitutionalized children had higher systolic blood pressure (P = .018), augmentation index (P= .033), total cholesterol (P= .047), low-density lipoprotein cholesterol (P= .03), triglycerides (P= .048), insulin (P= .005), and HOMA-IR (P= .01) values. The postinstitutionalized children had a lower low-frequency to high-frequency ratio (P = .008), indicating lower sympathetic tone, as well as a lower total lean mass (P = .016), a lower gynoid lean mass (P = .039), and a higher proportion of trunk tissue fat (P = .017). The postinstitutionalized and control children did not differ in any other body composition measures.

CONCLUSIONS

Early life stress, as represented by height-stunted growth in institutional care, may be associated with early pathways to cardiovascular and metabolic risk in youths even after moving into well-resourced homes early in life and in the absence of increased adiposity. These findings suggest that postinstitutionalized youths with a history of height stunting may need to be closely monitored for emergent cardiometabolic risk factors.

Social touch during development: Long-term effects on brain and behavior

In this paper, our goal is to explore what is known about the role of social touch during development. We first address the neural substrates of social touch and the role of tactile experience in neural development. We discuss natural variation in early exposure to social touch, followed by a discussion on experimental manipulations of social touch during development and "natural experiments", such as early institutionalization. We then consider the role of other developmental and experiential variables that predict social touch in adults. Throughout, we propose and consider new theoretical models of the role of social touch during development on later behavior and neurobiology.

Metabolic dysfunction in a rat model of early-life scarcity-adversity: Modulatory role of cafeteria diet

NEW FINDINGS

What is the central question of this study? Early-life adversity is associated with increased risk for obesity and metabolic dysfunction. However, it is unclear whether obesity and metabolic dysfunction result from coping strategies to deal with adversity-related emotional dysregulation, a direct programming of systems regulating metabolic function, or a combination of both. What is the main finding and its importance? Early-life adversity increases vulnerability to later-life obesity and metabolic dysfunction, indicating that genetics and adult lifestyle are not the only determinants of obesity and related metabolic dysfunction. Moreover, consumption of cafeteria diet exacerbated metabolic dysfunction associated with early-life adversity, suggesting that poor dietary choices might have a bigger impact in the context of early-life adversity.

ABSTRACT

Early-life adversity has become recognized as an important factor contributing to adult obesity and associated metabolic dysfunction. However, it is unclear whether obesity and metabolic dysfunction associated with early-life adversity result from coping strategies to deal with adversity-related emotional dysregulation, a direct programming of systems regulating metabolic function, or a combination. Interestingly, both early-life adversity and later-life dietary choices affect immune function, favouring pro-inflammatory mechanisms that are associated with obesity-related metabolic dysfunction. To investigate the unique and/or interactive effects of early-life adversity and later-life dietary choices for increased vulnerability to obesity and metabolic dysfunction, and specifically the role of the immune system in this vulnerability, we combined a naturalistic rat model of early-life scarcity-adversity with a rat model of obesity, the cafeteria diet. Our results indicate that early-life adversity alone induces insulin resistance, reduces pancreatic insulin secretion, plasma concentrations of triglycerides and cholesterol, and increases fasting glucose and tumour necrosis factor-α plasma concentrations. Importantly, animals exposed to adverse rearing were more vulnerable to metabolic dysregulation associated with the cafeteria diet, given that they consumed more energy, showed more severe hepatic steatosis and increased concentrations of the pro-inflammatory cytokine interleukin-1β than normally reared animals fed the cafeteria diet. Together, our results suggest that early-life adversity negatively programmes physiological systems that regulate metabolic function and increases vulnerability to obesity and metabolic dysfunction in adulthood. These results highlight the intrinsic relationship between the quality of the early postnatal environment and later-life dietary choices on adult health outcomes.

Growth recovery in newly arrived international adoptees in Italy: relation to parenting stress

BACKGROUND

Following initial adversities, most internationally adopted children arrive with significant growth delays. Postplacement recovery has been widely documented, but research about risk or protective factors is still limited. Even less is known about the relationship between growth recovery and the quality of the family environment.

METHODS

Twenty-eight children in 26 adoptive families were involved in this longitudinal study. A comprehensive evaluation (including anthropometry, cognitive assessment [using the Leiter International Performance Scale-Revised], and completion by both parents of the Parenting Stress Index - Short Form) was done at arrival of the child, and 1 year later.

RESULTS

Results evidenced that on arrival nearly half of children had growth measurements in the normal range. All the children showed a significant recovery in height and weight at 6 and 12 months postplacement. Initial and follow-up growth measurements correlated strongly. Growth recovery was related to the age of the child at adoption, the proportion of time the child had resided in institutional care, as well as parenting stress. Results suggested that the higher the parenting stress experienced the less improvements occurred in children: for mothers for height and weight, for fathers for all the growth indicators.

CONCLUSIONS

Results suggested the critical importance of family factor in influencing children's growth recovery.

The Effect of a Social-Emotional Intervention on the Development of Preterm Infants in Institutions

This study examined the effect of a social-emotional intervention implemented in one St. Petersburg (Russian Federation) institution (called a Baby Home, BH) on the general behavioral development of preterm children (gestational ages of 30-36 weeks) during their first two years of life. The intervention consisted of training caregivers and implementing structural changes to create a more family-like environment. The study included preterm (N = 56) and full-term (N = 93) children from one BH that implemented the intervention and from another BH with no intervention. Children were assessed at 3, 6, 9, 12, 18 and 24 months of age with the Battelle Development Inventory (LINC Associates, 1988). The results showed that the intervention positively influenced the general behavioral development of BH preterm children throughout their first two years of life compared to preterms from the no-intervention BH. Also, results indicated that the intervention effect was developmentally similar for preterm and for full-term children, but preterm children consistently scored lower than full-terms during their first two years living in the BH. In general, our research emphasizes the crucial role of warm, sensitive, and responsive interactions with a constant and emotionally available caregiver for healthy child development for both term and preterm children.

Peer Problems Among Postinstitutionalized, Internationally Adopted Children: Relations to Hypocortisolism, Parenting Quality, and ADHD Symptoms

Seventy-eight postinstitutionalized (PI) children adopted at ages 17-36 months were assessed 2, 8, 16, and 24 months postadoption on measures of cortisol and parenting quality, and compared to same-aged children adopted from foster care (FC, n = 45) and nonadopted children (NA, n = 45). In kindergarten (M_age  = 6.0 years), teachers, parents, and trained observers completed measures of peer relationships and attention deficit hyperactivity disorder (ADHD) symptoms. PI children had more peer problems and ADHD symptoms according to teachers and observers than NA children with FC children in between, whereas both PI and FC children were at significantly greater risk of hypocortisolism (i.e., blunted cortisol diurnal rhythm and reactivity). Hypocortisolism and ADHD symptoms mediated the association between preadoption adversity and peer difficulties. Higher postadoption parenting quality was protective.

CAREGIVER-CHILD INTERACTION, CAREGIVER TRANSITIONS, AND GROUP SIZE AS MEDIATORS BETWEEN INTERVENTION CONDITION AND ATTACHMENT AND PHYSICAL GROWTH OUTCOMES IN INSTITUTIONALIZED CHILDREN

This report describes a secondary analysis of data from a comprehensive intervention project which included training and structural changes in three Baby Homes in St. Petersburg, Russian Federation. Multiple mediator models were tested according to the R.M. Baron and D.A. Kenny () causal-steps approach to examine whether caregiver-child interaction quality, number of caregiver transitions, and group size mediated the effects of the intervention on children's attachment behaviors and physical growth. The study utilized a subsample of 163 children from the original Russian Baby Home project, who were between 11 and 19 months at the time of assessment. Results from comparisons of the training and structural changes versus no intervention conditions are presented. Caregiver-child interaction quality and number of caregiver transitions fully mediated the association between intervention condition and attachment behavior. No other mediation was found. Results suggest that the quality of interaction between caregivers and children in institutional care is of primary importance to children's development, but relationship context may play a less direct mediational role, supporting caregiver-child interactions.

Early growth faltering in post-institutionalized youth and later anthropometric and pubertal development

BackgroundEarly-life adversity that increases the risk of growth stunting is hypothesized to increase the risk of obesity and, in girls, early-onset puberty. This hypothesis was tested in children adopted from orphanages.MethodsPost-institutionalized (PI) youth were compared with youth reared in comparable families (non-adopted; NA) on height, weight, pubertal stage, and fat mass (127 PI, 80 female; 156 NA, 85 female, aged 7-14 years). Anthropometric findings at adoption were obtained from first US clinic visits.ResultsOverall, 25% of PI youth were height-stunted (<3rd percentile) at adoption. Years post adoption, PI youth had lower BMI-for-age (P=0.004), height-for-age (P<0.001), and less body fat (P<0.001) than NA youth had, but they did not differ by sex. Pubertal status did not differ by group or sex. The anthropometric findings held when the stunted-at-adoption subset was examined; they were also less likely to be in central puberty than other PI youth.ConclusionEarly deprived orphanage care increases the risk of growth stunting but not obesity in children adopted into US families, and it does not independently contribute to early-onset puberty for PI girls. The role of the environment following early adversity may modify the impact of early adverse care.

Pubertal Stress and Nutrition and their Association with Sexual Orientation and Height in the Add Health Data

A number of studies have indicated that gay men tend to be shorter, on average, than heterosexual men. Less evidence exists that lesbian women are taller, on average, than heterosexual women. The most popular explanation of the association between sexual orientation and height involves prenatal factors, such that, for example, gay men may have been exposed to lower than typical androgens during fetal development, which impacts their height and sexual orientation as adults. An alternative explanation involves stress, given that stress has been associated with sexual minority identification and with lower height. Another alternative explanation involves nutrition, although its relationship is less clear with sexual minority identification. Using the Add Health data, which is a large, nationally representative and longitudinal sample of American adolescents (n = 14,786), we tested a mediation model, such that sexual orientation → pubertal stress/nutrition → height. Within men, we found that gay men (n = 126) were shorter, on average, than heterosexual men (n = 6412). None of the 24 pubertal stress-related and 15 pubertal nutrition-related variables assessed in the Add Health data mediated the relationship between sexual orientation and height in men. Within women, lesbians (n = 75) did not differ significantly in stature compared to heterosexual women (n = 6267). Thus, prenatal mechanisms (e.g., hormones, maternal immune response) are likely better candidates for explaining the height difference between gay men and heterosexual men.

Sexual Orientation, Objective Height, and Self-Reported Height

Studies that have used mostly self-reported height have found that androphilic men and women are shorter than gynephilic men and women, respectively. This study examined whether an objective height difference exists or whether a psychosocial account (e.g., distortion of self-reports) may explain these putative height differences. A total of 863 participants, recruited at a Canadian university, the surrounding region, and through lesbian, gay, bisexual, and transgender (LGBT) events across Canada, self-reported their height and had their height measured. Androphilic men were shorter, on average, than gynephilic men. There was no objective height difference between gynephilic, ambiphilic, and androphilic women. Self-reported height, statistically controlling for objective height, was not related to sexual orientation. These findings are the first to show an objective height difference between androphilic and gynephilic men. Also, the findings suggest that previous studies using self-reported height found part of a true objective height difference between androphilic and gynephilic men. These findings have implications for existing biological theories of men's sexual orientation development.

Does Lack of "Genetic-Relative Family Health History" Represent a Potentially Avoidable Health Disparity for Adoptees?

Many adoptees face a number of challenges relating to separation from biological parents during the adoption process, including issues concerning identity, intimacy, attachment, and trust, as well as (for older adopted children) language and other cultural challenges. One common health challenge faced by adoptees involves lack of access to genetic-relative family health history (GRFHx). Lack of GRFHx represents a disadvantage due to a reduced capacity to identify diseases and recommend appropriate screening for conditions for which the adopted person may be at increased risk. In this article, we draw out common features of traditionally understood "health disparities" in order to identify analogous features in the context of adoptees' lack of GRFHx.

Differential DNA methylation in peripheral blood mononuclear cells in adolescents exposed to significant early but not later childhood adversity

Internationally adopted adolescents who are adopted as young children from conditions of poverty and deprivation have poorer physical and mental health outcomes than do adolescents conceived, born, and raised in the United States by families similar to those who adopt internationally. Using a sample of Russian and Eastern European adoptees to control for Caucasian race and US birth, and nonadopted offspring of well-educated and well-resourced parents to control for postadoption conditions, we hypothesized that the important differences in environments, conception to adoption, might be reflected in epigenetic patterns between groups, specifically in DNA methylation. Thus, we conducted an epigenome-wide association study to compare DNA methylation profiles at approximately 416,000 individual CpG loci from peripheral blood mononuclear cells of 50 adopted youth and 33 nonadopted youth. Adopted youth averaged 22 months at adoption, and both groups averaged 15 years at testing; thus, roughly 80% of their lives were lived in similar circumstances. Although concurrent physical health did not differ, cell-type composition predicted using the DNA methylation data revealed a striking difference in the white blood cell-type composition of the adopted and nonadopted youth. After correcting for cell type and removing invariant probes, 30 CpG sites in 19 genes were more methylated in the adopted group. We also used an exploratory functional analysis that revealed that 223 gene ontology terms, clustered in neural and developmental categories, were significantly enriched between groups.

The Development of Children Placed into Different Types of Russian Families Following an Institutional Intervention

This study examined whether interventions in Russian Baby Homes promoting warm, sensitive, and responsive caregiver-child interactions and relationships would be associated with advantages in those children's behavior years after they transitioned to family care. Children (N = 135) who had resided for at least 3 months (M = 13.8 months) in one of three intervention institutions were subsequently placed in Russian families (relatives or non-relatives) for at least 1 year (M = 33.5 months). When children were 1.5-10.8 years of age, parents provided ratings of attachment, indiscriminate friendliness, executive functioning, social-emotional development, and behavior problems. Despite very substantial differences in the developmental status of children at departure from the three institutions, there were fewer than expected significant differences between children from the three institutions at follow-up or as a function of being placed with relatives or non-relatives. Specifically, children reared in the most improved institution displayed less indiscriminate friendliness, were less aggressive/defiant, and had less externalizing behavior. Children from all three institutions who were placed into families at older ages tended to be rated more poorly on some measures. These results suggest that previously institutionalized children adjust well to family life, but improved institutional caregiving can have some persistent benefits over several years in children transitioned to families.

Predictors of developmental status in young children living in institutional care in Kazakhstan

The main objective of this study was to assess the developmental status of children living in the severely adverse environment of institutional care and the examination of risk factors with regard to developmental status, including degree of stunting and emotional-behavioral and anemia status. The Bayley Scales of Infant Development were used to assess development status in 103 children aged 14.9 months (SD = 6.8) in six Kazakh institutions. The Behavioral Rating Scales were used to assess emotional-behavioral regulation. Physical growth measures were converted to z scores using World Health Organization growth charts. Venous blood was collected for assessment of anemia. Our findings indicated that young children in institutions were developmentally compromised, with duration of institutional care correlated with the severity of delay. Negative predictors of developmental status included: Poor emotional-behavioral regulation, degree of stunting and age at assessment. A particularly large percentage of children were found to be anemic. Additionally, low birth weight was found to be a significant negative predictor of development. Our findings indicate that institutional care has a detrimental impact on the development and emotional regulation of young children. Time in institutional care is a negative predictor for cognitive status for children placed at birth. Moreover stunting was found to be a useful indicator of the degree of impact of early adversity on cognitive development. Particular attention is needed for special-needs children such as those with low birth weight, since their development was found to be more sensitive to early adversity than that of normal birth weight children.

Associations between physical growth and general cognitive functioning in international adoptees from Eastern Europe at 30 months post-arrival

Background

Internationally adopted children have often experienced early adversity and growth suppression as a consequence of institutional care. Furthermore, these children are at risk for impaired cognitive development due to their early adverse experiences. This study examined the association between physical growth, the growth hormone (GH) system, and general cognitive functioning post-adoption. Based on previous research, we expected to find that a child’s initial physical growth status and normalization of the growth hormone-insulin-like growth factor 1 (GH-IGF-1) axis would be positive predictors of general cognitive functioning.

Methods

Post-institutionalized children (n = 46) adopted from Eastern Europe were seen approximately 1 month after their arrival into the USA to determine baseline measurements. They were seen again 6 and 30 months later for two follow-up sessions. Measures included anthropometry, insulin-like growth factor-1 (IGF-1), IGF binding protein-3 (IGFBP-3), Mullen Scales of Early Learning, and Stanford-Binet Intelligence Scales. Information about parental education was also collected.

Results

We found that a child’s general cognitive functioning at 30 months post-adoption was predicted by their general developmental scores at 6 months post-adoption, their initial height status, and markers of the growth hormone system. Children with lower initial IGFBP-3 standard deviation (SD) scores had higher verbal IQ scores at 30 months. Furthermore, a child’s initial height was found to be a significant positive predictor of non-verbal IQ.

Conclusions

These results suggest an association between a child’s suppressed physical growth in response to early adversity and alterations in GH system functioning and subsequent recovery in cognitive functioning.

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

It has been more than 80 years since researchers in child psychiatry first documented developmental delays among children separated from family environments and placed in orphanages or other institutions. Informed by such findings, global conventions, including the 1989 UN Convention on the Rights of the Child, assert a child's right to care within a family-like environment that offers individualised support. Nevertheless, an estimated 8 million children are presently growing up in congregate care institutions. Common reasons for institutionalisation include orphaning, abandonment due to poverty, abuse in families of origin, disability, and mental illness. Although the practice remains widespread, a robust body of scientific work suggests that institutionalisation in early childhood can incur developmental damage across diverse domains. Specific deficits have been documented in areas including physical growth, cognitive function, neurodevelopment, and social-psychological health. Effects seem most pronounced when children have least access to individualised caregiving, and when deprivation coincides with early developmental sensitive periods. Offering hope, early interventions that place institutionalised children into families have afforded substantial recovery. The strength of scientific evidence imparts urgency to efforts to achieve deinstitutionalisation in global child protection sectors, and to intervene early for individual children experiencing deprivation.

Perspectiva Cultural del Desarrollo Infantil en las Instituciones de Protección

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

Effect of the Nature of Subsequent Environment on Oxytocin and Cortisol Secretion in Maltreated Children

Childhood maltreatment (CM), including abuse and neglect, is a crucial factor that distorts child development. CM is associated with alterations in numerous brain regions, and may be associated with hormonal dysregulation. This study aimed to investigate differences in secretion patterns of cortisol (CT) and oxytocin (OT) among children who experienced CM, children living in residential care facilities and in unstable environments. Among 38 maltreated children, 23 (mean age = 12.2 years, SD = 3.0) were categorized as "Settled" and 15 (mean age = 13.1 years, SD = 2.2) as "Unsettled." Twenty-six age- and gender-matched (mean age = 12.6 years, SD = 2.1), typically developing (TD) children were also included. Clinical and psychological assessments, including IQ and trauma evaluations, were conducted for all participants. Age, gender, and full-scale IQ were used as covariates in hormone analysis. Two saliva samples were collected, one on awakening and the other at bedtime. There were significant differences in the awakening CT levels of the "Unsettled" group, and in bedtime OT levels in the "Settled" group as compared with TD children, and between CM groups. Furthermore, there was a significant difference in trauma-symptomatic depression scores between the "Settled" and "Unsettled" CM group. These results suggest that CT diurnal secretions tend to be reactive to current stress rather than previous experience. OT diurnal secretions are presumably hyper-regulated for coping with the environment to survive and thrive. By measuring salivary CT/OT diurnal patterns, hormonal dysregulation of CM children living in "Settled" environments and "Unsettled" environments was indicated.

Skeletal manifestations of stress in child victims of the Great Irish Famine (1845-1852): prevalence of enamel hypoplasia, Harris lines, and growth retardation

The Great Irish Famine of 1845-1852 is among the worst food crises in human history. While numerous aspects of this period have been studied by generations of scholars, relatively little attention has so far been given to the physiological impact it is likely to have had on the people who suffered and succumbed to it. This study examines the prevalence of enamel hypoplasia, Harris lines, and growth retardation in the nonadult proportion of a skeletal population comprising victims of the Famine who died in the workhouse in the city of Kilkenny between 1847 and 1851. The frequency of enamel hypoplasia in these children does not appear to have increased as a consequence of famine, although this fact is likely to be a reflection of the osteological paradox. Harris lines and growth retardation; however, were very prevalent, and the manifestation and age-specific distribution of these may be indicators of the Famine experience. While there was no clear correlation in the occurrence of the assessed markers, the presence of cribra orbitalia displayed a significant relationship to enamel hypoplasia in 1- to 5-year-old children. While starvation, metabolic disorders and infectious diseases are likely to have greatly contributed to the manifestation of the markers, the psychosocial stress relating to institutionalization in the workhouse should not be underestimated as a substantial causative factor for skeletal stress in this population.

Adoption: biological and social processes linked to adaptation

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

Cortisol secretion in children with symptoms of reactive attachment disorder

Maltreated children with reactive attachment disorder (RAD) have severe problems with social relationships and affect regulation. An association between early maltreatment and changes in the daily rhythm of cortisol secretion has already been reported for maltreated toddlers. We sought to find out whether such changes were apparent in school-age children with symptoms of RAD, who had experienced early maltreatment but were currently adopted in well-functioning families. We recruited 66 children: 34 adopted children, aged 5-12 years, with an early history of maltreatment and with social difficulties such as indiscriminate friendliness; and 32 age- and sex-matched comparison children with no history of maltreatment or social difficulties. Daily rhythms of cortisol production were determined from saliva samples collected over 2 days. The adopted group had significantly lower absolute levels of cortisol compared to the control group, but a typical profile of cortisol secretion. There was no association between cortisol secretion and symptom scores for psychopathology.

Structure, Caregiver–Child Interactions, and Children’s General Physical and Behavioral Development in Three Central American Institutions

This article describes structural characteristics and caregiver–child interactions ( N = 34) in three Central American institutions for infants and young children ( N = 79) and relates differences in these characteristics to differences in children’s physical, behavioral, and cognitive development. Generally, the institution with the smallest group size, fewest children per caregiver, and a few consistent caregivers had children with the best physical, behavioral, and cognitive development; this institution also had many temporary volunteers who played with the children. Differences in the quality of caregiver–child interactions were not directly related to children’s development, but the potential benefit of high-quality interactions may have been minimized by a high children:caregiver ratio in one institution, and the presence of volunteers to play with children may have compensated for and/or minimized the display of higher-quality interactions by staff caregivers in another institution.

Diverse physical growth trajectories in institutionalized Portuguese children below age 3: relation to child, family, and institutional factors

OBJECTIVE

To identify and analyze diverse longitudinal trajectories of physical growth of institutionalized children and their relation to child, family, and institutional factors.

METHODS

49 institutionalized children were studied for 9 months after admission. Weight, height, and head circumference were measured on 4 occasions, beginning at admission. Data were analyzed using latent class analysis, yielding diverse patterns of growth for each feature, and relations with child characteristics, early family risk factors, and institutional relational care were investigated.

RESULTS

For each growth feature, 4 classes emerged: "Persistently Low," "Improving," "Deteriorating," and "Persistently High." Younger age at admission was a risk factor for impaired physical growth across all domains. Physical characteristics at birth were associated with trajectories across all domains. Lower prenatal risk and better institutional relational care were associated with Improving weight over time.

CONCLUSIONS

Discussion highlights the role of children's physical features at birth, prenatal risk, and caregiver's cooperation with the child in explaining differential trajectories.