Telomere length and early severe social deprivation: linking early adversity and cellular aging

Written by Zach Morrow on . Posted in Longterm Consequences of Orphanhood. Leave a Comment

Study Title: Telomere length and early severe social deprivation: linking early adversity and cellular aging

Authors: S S Drury, K Theall, M M Gleason, A T Smyke, I De Vivo, J Y Y Wong, N A Fox, C H Zeanah and C A Nelson

Abstract: Accelerated telomere length attrition has been associated with psychological stress and early adversity in adults; however, no studies have examined whether telomere length in childhood is associated with early experiences. The Bucharest Early Intervention Project is a unique randomized controlled trial of foster care placement compared with continued care in institutions. As a result of the study design, participants were exposed to a quantified range of time in institutional care, and represented an ideal population in which to examine the association between a specific early adversity, institutional care and telomere length. We examined the association between average relative telomere length, telomere repeat copy number to single gene copy number (T/S) ratio and exposure to institutional care quantified as the percent of time at baseline (mean age 22 months) and at 54 months of age that each child lived in the institution. A significant negative correlation between T/S ratio and percentage of time was observed. Children with greater exposure to institutional care had significantly shorter relative telomere length in middle childhood. Gender modified this main effect. The percentage of time in institutional care at baseline significantly predicted telomere length in females, whereas the percentage of institutional care at 54 months was strongly predictive of telomere length in males. This is the first study to demonstrate an association between telomere length and institutionalization, the first study to find an association between adversity and telomere length in children, and contributes to the growing literature linking telomere length and early adversity.

[button link=”http://www.nature.com/mp/journal/v17/n7/full/mp201153a.html” color=”lightblue” newwindow=”yes”] Read More[/button]

Timing of Intervention Affects Brain Electrical Activity in Children Exposed to Severe Psychosocial Neglect

Written by Zach Morrow on . Posted in Longterm Consequences of Orphanhood, Uncategorized. Leave a Comment

Study Title: Timing of Intervention Affects Brain Electrical Activity in Children Exposed to Severe Psychosocial Neglect

Authors: Ross E. Vanderwert, Peter J. Marshall, Charles A. Nelson III, Charles H. Zeanah, Nathan A. Fox

Abstract:

Background

Early psychosocial deprivation has profound effects on brain activity in the young child. Previous reports have shown increased power in slow frequencies of the electroencephalogram (EEG), primarily in the theta band, and decreased power in higher alpha and beta band frequencies in infants and children who have experienced institutional care.

Methodology/Principal Findings

We assessed the consequences of removing infants from institutions and placing them into a foster care intervention on brain electrical activity when children were 8 years of age. We found the intervention was successful for increasing high frequency EEG alpha power, with effects being most pronounced for children placed into foster care before 24 months of age.

Conclusions/Significance

The dependence on age of placement for the effects observed on high frequency EEG alpha power suggests a sensitive period after which brain activity in the face of severe psychosocial deprivation is less amenable to recovery.

 

 
[button link=”http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0011415″ color=”lightblue” newwindow=”yes”] Read More[/button]

Stereotypies in Children With a History of Early Institutional Care

Written by Zach Morrow on . Posted in Psychological Effects of Orphanhood, Uncategorized. Leave a Comment

Authors: Karen J. Bos; Charles H. Zeanah Jr, MD; Anna T. Smyke, PhD; Nathan A. Fox, PhD; Charles A. Nelson III, PhD

Abstract:

Objectives  To investigate the prevalence of stereotypies in children with a history of early institutional care, evaluate the efficacy of a foster care intervention compared with institutional care on the course of stereotypies, and describe correlates in language, cognition, and anxiety for children who exhibit stereotypies.

Design  Randomized controlled trial.

Setting  Institutions in Bucharest, Romania.

Participants  One hundred thirty-six children with a history of early institutional care.

Intervention  Comparison of a foster care intervention with continued care as usual in an institution.

Main Outcome Measures  The presence of stereotypies as well as outcomes in language, cognition, and anxiety.

Results  At the baseline assessment prior to placement in foster care (average age of 22 months), more than 60% of children in institutional care exhibited stereotypies. Follow-up assessments at 30 months, 42 months, and 54 months indicated that being placed in families significantly reduced stereotypies, and with earlier and longer placements, reductions became larger. For children in the foster care group, but not in the care as usual group, stereotypies were significantly associated with lower outcomes on measures of language and cognition.

Conclusions  Stereotypies are prevalent in children with a history of institutional care. A foster care intervention appears to have a beneficial/moderating role on reducing stereotypies, underscoring the need for early placement in home-based care for abandoned children. Children who continue to exhibit stereotypies after foster care placement are significantly more impaired on outcomes of language and cognition than children without stereotypies and thus may be a target for further assessments or interventions.

Trial Registration  clinicaltrials.gov Identifier: NCT00747396

Stereotypies are defined as repetitive, invariant movements with no obvious goal or function.1 Stereotypies may occasionally be seen in typically developing children but are more commonly associated with a number of different medical conditions, including autism and mental retardation. In addition, stereotypies are known to develop in association with atypical and especially restricted sensory environments or deprivation.1 The association of stereotypies with disorders of the central nervous system suggests a neurological basis, but the underlying cause, pathophysiology, and possible approaches for treatment all require further investigation.

In this article, we focus on stereotypies associated with early psychosocial deprivation. Most of our understanding of stereotypies associated with sensory-restricted environments comes from animal models. Stereotypies are the most common form of abnormal behavior found in caged animals, and animal models of deprivation-induced stereotypies have been found across many species. In these animal models, stereotypies have been linked to alterations in the cortical–basal ganglia circuitry.

Human models of severe psychosocial deprivation in early childhood are understandably more limited. However, there are case reports of previously healthy children who developed stereotypies after exposure to prolonged extreme deprivation. In 1 case, a typically developing, healthy, 3-year-old girl in Thailand exhibited a number of motor stereotypies after being isolated in a cage for 6 years. Four years after her reintegration into the community, she showed considerable improvement including the elimination of stereotypies, but she continued to have many developmental difficulties, particularly with speech.

Children raised in institutions provide another unfortunate but important group in which to study the effects of extreme early psychosocial deprivation, including the presence of stereotypies. Institutionalized children are known to exhibit deficits across numerous domains of functioning, including physical, psychiatric, and cognitive outcomes. There are a few reports in the literature suggesting an increased incidence and severity of motor stereotypies in this population, believed to be caused by the restricted sensory environment limiting typical input. Hypotheses for the functional significance of stereotypies in this environment include attempts at self-stimulating, coping mechanisms for self-soothing, or expressions of frustration or anxiety, particularly in children who lack adequate verbal communication skills.

An important issue that has not been addressed to date, to our knowledge, is a systematic study of the reduction or elimination of deprivation-induced stereotypies by restitution of enhanced caregiving environments. One report in the literature suggests a reduction in stereotypies after adoption and calls for additional research in this area. In this study of 46 children adopted from Romanian orphanages by families in British Columbia, Canada, 84% of caregivers reported the presence of stereotypies at the time of placement. The average age of the children at adoption was 18.5 months, and the mean time spent in institutions prior to adoption was 17.5 months. By the time the interview for the study was conducted (a median of 11 months after placement with the adopted family), 98% of stereotyped behavior problems were reported by caregivers to have shown some improvement or to be completely resolved. However, since children in this study were not randomly assigned to foster care placement, the application of these results to all children with a history of early institutional care is limited by selection bias. In addition, the study reports findings from only 1 assessment after placement and therefore does not provide data on stereotypies at later ages.

In the current study, we draw on data from the Bucharest Early Intervention Project (BEIP), a study of current and formerly institutionalized children in Romania. The BEIP is unique in its ability to evaluate directly the effects of early family placement rather than institutional care for young children because the participants were institutionalized children randomly assigned either to continued care as usual in the institution or to a foster care intervention. The BEIP is the first such randomized clinical trial to evaluate foster care as an alternative to institutional care for abandoned children. Because the children enrolled in this study were closely followed up longitudinally, this study also provides the unusual opportunity within the population of institutionalized children to investigate the course of stereotypies in children exposed to extreme deprivation and the presence of sensitive periods for the development or remediation of stereotypies.

This study addressed the following questions: (1) How many young children being raised in institutions exhibit stereotypies? (2) For children with a history of early institutionalization, does placement in a foster care intervention reduce or eliminate stereotypies? If so, is there an effect of timing of placement? (3) To characterize those children who continue to exhibit stereotypies compared with those whose stereotypies resolve, are there any correlates of stereotypies that we can identify in this population, particularly focusing on outcomes in language, cognition, and anxiety?

 

 

[button link=”http://archpedi.jamanetwork.com/article.aspx?articleid=383173″ color=”lightblue” newwindow=”yes”] Read More[/button]

Placement in foster care enhances quality of attachment among young institutionalized children

Written by Reese Sim on . Posted in Emotional Wellbeing. Leave a Comment

Study Title: Placement in foster care enhances quality of attachment among young institutionalized children

Authors: Smyke, A.T., Zeanah, C.H., Fox, N.A., Nelson, C.A., & Guthrie, D.

Abstract: This study examined classifications of attachment in 42-month-old Romanian children (N = 169). Institutionalized since birth, children were assessed comprehensively, randomly assigned to care as usual (CAU) or to foster care, and compared to family-reared children. Attachment classifications for children in foster care were markedly different from those in the CAU. Importantly, children placed in foster care before 24 months were more likely to have secure attachments and if placed earlier were less likely to have disorganized or insecure-other attachments. Cognitive status predicted greater likelihood of organized attachment in the CAU and greater likelihood of secure attachment in the foster care and never-institutionalized groups. Foster care is an important intervention to reduce the adverse effects following early deprivation.

[button link=”http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8624.2009.01390.x/abstract” color=”lightblue” newwindow=”yes”] Read More[/button]

Delayed maturation in brain electrical activity partially explains the association between early environmental deprivation and symptoms of attention-deficit/hyperactivity disorder

Written by Reese Sim on . Posted in Psychological Effects of Orphanhood. Leave a Comment

Study Title: Delayed maturation in brain electrical activity partially explains the association between early environmental deprivation and symptoms of attention-deficit/hyperactivity disorder

Authors: McLaughlin, K.A., Fox, N.A., Zeanah, C.H., Sheridan, M. A., Marshall, P.J., & Nelson, C.A.

Abstract: Children raised in institutional settings are exposed to social and environmental circumstances that may deprive them of expected environmental inputs during sensitive periods of brain development that are necessary to foster healthy development. This deprivation is thought to underlie the abnormalities in neurodevelopment that have been found in previously institutionalized children. It is unknown whether deviations in neurodevelopment explain the high rates of developmental problems evident in previously institutionalized children, including psychiatric disorders. We present data from a sample of children raised in institutions in Bucharest, Romania (n = 117) and an age- and sex-matched sample of community control subjects (n = 49). Electroencephalogram data were acquired following entry into the study at age 6 to 30 months, and a structured diagnostic interview of psychiatric disorders was completed at age 54 months. Children reared in institutions evidenced greater symptoms of attention-deficit/hyperactivity disorder, anxiety, depression, and disruptive behavior disorders than community controls. Electroencephalogram revealed significant reductions in alpha relative power and increases in theta relative power among children reared in institutions in frontal, temporal, and occipital regions, suggesting a delay in cortical maturation. This pattern of brain activity predicted symptoms of hyperactivity and impulsivity at age 54 months, and significantly mediated the association between institutionalization and attention-deficit/hyperactivity disorder symptoms. Electroencephalogram power was unrelated to depression, anxiety, or disruptive behaviors. These findings document a potential neurodevelopmental mechanism underlying the association between institutionalization and psychiatric morbidity. Deprivation in social and environmental conditions may perturb early patterns of neurodevelopment and manifest as psychiatric problems later in life.

[button link=”http://www.sciencedirect.com/science/article/pii/S0006322310003495″ color=”lightblue” newwindow=”yes”] Read More[/button]

Stereotypies in children with a history of early institutional care

Written by Reese Sim on . Posted in Psychological Effects of Orphanhood. Leave a Comment

Study Title: Stereotypies in children with a history of early institutional care.

Authors: Bos, K., Zeanah, C.Z., Fox, N.A., & Nelson, C.A.

Abstract: To investigate the prevalence of stereotypies in children with a history of early institutional care, evaluate the efficacy of a foster care intervention compared with institutional care on the course of stereotypies, and describe correlates in language, cognition, and anxiety for children who exhibit stereotypies. The presence of stereotypies as well as outcomes in language, cognition, and anxiety. Results At the baseline assessment prior to placement in foster care (average age of 22 months), more than 60% of children in institutional care exhibited stereotypies. Follow-up assessments at 30 months, 42 months, and 54 months indicated that being placed in families significantly reduced stereotypies, and with earlier and longer placements, reductions became larger. For children in the foster care group, but not in the care as usual group, stereotypies were significantly associated with lower outcomes on measures of language and cognition. Conclusions: Stereotypies are prevalent in children with a history of institutional care. A foster care intervention appears to have a beneficial/moderating role on reducing stereotypies, underscoring the need for early placement in home-based care for abandoned children. Children who continue to exhibit stereotypies after foster care placement are significantly more impaired on outcomes of language and cognition than children without stereotypies and thus may be a target for further assessments or interventions.

[button link=”http://archpedi.jamanetwork.com/article.aspx?articleid=383173″ color=”lightblue” newwindow=”yes”] Read More[/button]

Institutional rearing and psychiatric disorders in Romanian preschool children

Written by Reese Sim on . Posted in Psychological Effects of Orphanhood. Leave a Comment

Study Title: A new model of foster care for young children: The Bucharest Early Intervention Project

Authors: Zeanah, C.H., Egger. H.L., Smyke, A.T., Nelson, C.A., Fox, N.A., Marshall, P.J., & Guthrie, D.

Abstract: There is increasing interest in the relations between adverse early experiences and subsequent psychiatric disorders. Institutional rearing is considered an adverse caregiving environment, but few studies have systematically examined its effects. This study aimed to determine whether removing young children from institutional care and placing them with foster families would reduce psychiatric morbidity at 54 months of age. Method: Young children living in institutions in Bucharest were enrolled when they were between 6 and 30 months of age. Following baseline assessment, 136 children were randomly assigned to care as usual (continued institutional care) or to removal and placement in foster care that was created as part of the study. Psychiatric disorders, symptoms, and comorbidity were examined by structured psychiatric interviews of caregivers of 52 children receiving care as usual and 59 children in foster care when the children were 54 months of age. Both groups were compared to 59 typically developing, never-institutionalized Romanian children recruited from pediatric clinics in Bucharest. Foster care was created and supported by social workers in Bucharest who received regular consultation from U.S. clinicians. Results: Children with any history of institutional rearing had more psychiatric disorders than children without such a history (53.2% versus 22.0%). Children removed from institutions and placed in foster families were less likely to have internalizing disorders than children who continued with care as usual (22.0% versus 44.2%). Boys were more symptomatic than girls regardless of their caregiving environment and, unlike girls, had no reduction in total psychiatric symptoms following foster placement. Conclusions: Institutional rearing was associated with substantial psychiatric morbidity. Removing young children from institutions and placing them in families significantly reduced internalizing disorders, although girls were significantly more responsive to this intervention than boys.

[button link=”http://ajp.psychiatryonline.org/article.aspx?articleID=100943&atab=7″ color=”lightblue” newwindow=”yes”] Read More[/button]

A new model of foster care for young children: The Bucharest Early Intervention Project

Written by Reese Sim on . Posted in Caregiving Situations and Living Environments. Leave a Comment

Study Title: A new model of foster care for young children: The Bucharest Early Intervention Project

Authors: Smyke, A.T., Zeanah, C.H., Fox, N.A., & Nelson, C.A.

Abstract: The Bucharest Early Intervention Project is a randomized controlled trial of foster care as an intervention for young children who have spent most of their lives in institutions in Bucharest, Romania. The authors implemented an attachment-based model of child-centered foster care there, and a team of three Romanian social workers trained and supported foster parents in managing the complex challenges of caring for postinstitutionalized infants and toddlers. They received regular weekly consultation from US-based clinicians designed to guide their work with foster parents and children. From language development to toilet training to encouraging the development of the young child’s ability to trust, foster parents received ongoing support to help these young children transition to family life. Developmental outcomes so far indicate significantly better outcomes for young children in this foster care program than children who remained in institutions. For some domains of development, earlier placement was associated with better outcomes but for others, timing of placement did not appear to matter.

[button link=”http://www.ncbi.nlm.nih.gov/pubmed/19486847″ color=”lightblue” newwindow=”yes”] Read More[/button]

Effects of early psychosocial deprivation on the development of memory and executive function

Written by Reese Sim on . Posted in Psychological Effects of Orphanhood. Leave a Comment

Study Title: Effects of early psychosocial deprivation on the development of memory and executive function

Authors: Bos, Karen J., Fox, N., Zeanah, C.H., & Nelson, C.N.

Abstract: This study investigated the effects of early institutional care on memory and executive functioning. Subjects were participants in the Bucharest Early Intervention Project (BEIP) and included institutionalized children, children with a history of institutionalization who were assigned to a foster care intervention, and community children in Bucharest, Romania. Memory and executive functioning were assessed at the age of 8years using the Cambridge Neuropsychological Test and Automated Battery (CANTAB). As expected, children with a history of early institutional care performed worse on measures of both visual memory and executive functioning compared to their peers without a history of institutional care. In comparing children randomly assigned to the foster care intervention with their peers who had continued care in the institution, initial comparisons did not show significant differences on any of the memory or executive functioning outcomes. However, for one of the measures of executive functioning, after controlling for birth weight, head circumference, and duration of time spent in early institutional care, the foster care intervention was a significant predictor of scores. These results support and extend previous findings of deficits in memory and executive functioning among school-age children with a history of early deprivation due to institutional care. This study has implications for the millions of children who continue to experience the psychosocial deprivation associated with early institutional care.

[button link=”http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2741295/” color=”lightblue” newwindow=”yes”] Read More[/button]

Cognitive recovery in socially deprived young children: The Bucharest Early Intervention Project

Written by Reese Sim on . Posted in Psychological Effects of Orphanhood. Leave a Comment

Study Title: Cognitive recovery in socially deprived young children: The Bucharest Early Intervention Project

Authors: Nelson, C.A., Zeanah, C.H., Fox, N.A., Marshall, P. J., Smyke, A.T., & Guthrie, D.

Abstract: In a randomized controlled trial, we compared abandoned children reared in institutions to abandoned children placed in institutions but then moved to foster care. Young children living in institutions were randomly assigned to continued institutional care or to placement in foster care, and their cognitive development was tracked through 54 months of age. The cognitive outcome of children who remained in the institution was markedly below that of never-institutionalized children and children taken out of the institution and placed into foster care. The improved cognitive outcomes we observed at 42 and 54 months were most marked for the youngest children placed in foster care. These results point to the negative sequelae of early institutionalization, suggest a possible sensitive period in cognitive development, and underscore the advantages of family placements for young abandoned children.

[button link=”http://www.sciencemag.org/content/318/5858/1937.short” color=”lightblue” newwindow=”yes”] Read More[/button]

FOLLOW US FOR OVC UPDATES: