The long‐term effects of institutional rearing,foster care intervention and disruptions in care on brain electrical activity in adolescence

Exposure to early psychosocial deprivation as a result of institutional care disrupts typical brain development. The Bucharest Early Intervention Project (BEIP) is the first longitudinal study to investigate the neurodevelopment of institutionalized infants randomized to a foster care (FCG) intervention versus care as usual (CAUG). Here, we present findings from a follow‐up assessment of brain electrical activity as indexed by resting EEG at age 16 years. In addition, we examined the effects of disruption of foster care placement (e.g. the number of moves among foster care placements) on brain electrical activity. Resting‐state EEG was collected from 48 CAUG, 46 FCG and 48 never institutionalized (NIG) control participants. Absolute (µV²) and relative (proportion) power were computed from eyes closed, resting EEG data for theta, alpha and beta frequency bands. The CAUG displayed higher relative theta and lower relative alpha power compared to the FCG at 16 years of age. The FCG showed brain activity comparable to the NIG. The results further showed that disruptions following the original foster care placement had an adverse effect on brain electrical activity. Within the foster care group, there were no effects of age of placement on EEG power. Placement of children who have experienced early institutional rearing into stable foster care settings ensure long‐term improvement in brain functioning.     

Napping reduces emotional attention bias during early childhood

Sleep loss alters processing of emotional stimuli in preschool‐aged children. However, the mechanism by which sleep modifies emotional processing in early childhood is unknown. We tested the hypothesis that a nap, compared to an equivalent time spent awake, reduces biases in attention allocation to affective information. Children (n = 43; M = 55.40 months, SD = 8.05 months) completed a Dot Probe task, which provides a measure of attention biases to emotional stimuli, following a mid‐day nap and an equivalent interval spent awake. No emotional attention biases emerged when children napped. However, when nap‐deprived, children exhibited biases towards negative and positive stimuli. This emotional bias after wake was greater in children who napped habitually. Gender differences also emerged such that females were more attentive to positive emotional stimuli whereas males showed heightened attention to negative emotional stimuli, regardless of having napped or not. Moreover, greater slow wave activity (SWA) during the nap was associated with faster responding, which suggests that SWA may promote efficiency of attention allocation. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=JIoZ8mzxQgg     

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

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

The Effectiveness of an Attachment‐Based Intervention in Promoting Foster Mothers’ Sensitivity toward Foster Infants

Infants in foster care need sensitive, responsive caregivers to promote their healthy outcomes. The current study examined the effectiveness of the Attachment and Biobehavioral Catch‐up Intervention, a short‐term, targeted, attachment‐based intervention program designed to promote sensitive caregiving behavior among foster mothers. Ninety‐six foster mother–infant dyads participated in this study; 44 dyads were assigned to the Attachment and Biobehavioral Catch‐up Intervention, and 52 dyads were assigned to a control intervention. Results of hierarchical linear modeling indicated that foster mothers who were assigned to the Attachment and Biobehavioral Catch‐up Intervention showed greater improvements in their sensitivity from pre‐ to postintervention assessment time points when compared with foster mothers who were assigned to the control intervention. We conclude that a short‐term, targeted, attachment‐based intervention is effective in changing foster mothers’ responsiveness to their foster infants, which is critical for foster infants’ healthy socioemotional adjustment.     

Electrophysiological evidence of altered memory processing in children experiencing early deprivation

Associations between early deprivation and memory functioning were examined in 9- to 11-year-old children. Children who had experienced prolonged institutional care prior to adoption were compared to children who were adopted early from foster care and children reared in birth families. Measures included the Paired Associates Learning task from the Cambridge Neuropsychological Test and Automated Battery (CANTAB) and a continuous recognition memory task during which ERPs were also recorded. Children who experienced prolonged institutionalization showed deficits in both behavioral memory measures as well as an attenuated P300 parietal memory effect. Results implicate memory function as one of the domains that may be negatively influenced by early deprivation in the form of institutional care.     

Happy Family Kitchen: Behavioral Outcomes of a Brief Community-Based Family Intervention in Hong Kong

Positive psychology interventions commonly involve behavioral exercises to improve psychosocial well-being. Intervention effect on behavior is unclear. The Happy Family Kitchen project, one of the community-based brief intervention projects under The FAMILY: A Jockey Club Initiative for a Harmonious Society, was conducted in Hong Kong to develop and evaluate the effectiveness of a positive psychology family intervention. We have previously reported positive intervention effects on family communication, family well-being, and subjective happiness. This paper aims to explore the effectiveness of the intervention on behavioral outcomes and their associations with psychosocial well-being. A total of 23 social service units organized and conducted intervention programs for 1419 individuals from 612 families in Hong Kong. Each intervention was developed with emphasis on one of five positive psychology themes: gratitude, flow, happiness, health, and savoring. Intervention outcomes were assessed at pre-intervention, immediate post-intervention, and 6 weeks and 12 weeks post-intervention. Results showed that family communication time and frequency of meal preparation with family members increased with sustainable small effects up to 12 weeks. Theme-specific behavior change was observed in the gratitude, flow, and happiness interventions, respectively. Family communication time, frequency of eating with family members, and theme-specific behaviors, including gratitude, flow, happiness behavior, health attitude, and health behavior, were positively associated with psychosocial well-being. Qualitative data provided additional evidence of effectiveness with in-depth insights into behavior change. The positive associations between target behaviors and well-being suggest that improvements in well-being as a function of the intervention may be associated with behavior change.     

The effects of Promoting Alternative Thinking Strategies Preschool Program on teacher–children relationships and children's social competence in Turkey

This quasi‐experimental study examined the effects of the Promoting Alternative Thinking Strategies (PATHS) Preschool Program on the outcomes of children's social‐emotional competence, perceived relationships between teacher and children and teachers' ability to create a positive classroom atmosphere. Two hundred and eighty five children (48–72 months) and teachers in Izmir participated in the intervention, and 280 children (48–72 months) and teachers participated as comparison group. Intervention teachers implemented PATHS in their classrooms. For data triangulation, multiple sources of data were collected in the study. Classrooms were observed using two different scales. Teacher rated students using another two different scales. Children were assessed with an interview to evaluate their perceptions of relationships. Intervention group teachers reported greater improvement of children's social‐emotional skills, interpersonal relationship skills and emotion regulation. Furthermore, when observed intervention group children showed higher levels of pro‐social behaviour, increased levels of compliance, better problem solving skills and more positive feelings. Intervention group children also described their relationships with their teachers as significantly more positively. Finally, intervention group teachers perceived more dependency in their relationships with children.     

Enhancing the language development of toddlers in foster care by promoting foster parents’ sensitivity: Results from a randomized controlled trial

Young children in foster care are at increased risk for problematic language development, making early intervention a critical tool in enhancing these children's foundational language abilities. This study examined the efficacy of an early preventative intervention, Attachment and Biobehavioral Catch‐up for Toddlers (ABC‐T), in improving the receptive vocabulary abilities of toddlers placed in foster care. All the children had been removed from their biological parents’ care and placed into foster care. When children were between 24 and 36 months old, foster parents were contacted by research staff and consented to participate. Parents were randomly assigned using a random number generator to receive either ABC‐T (n = 45), which aimed to promote sensitive parenting for children who have experienced early adversity, or a control intervention (n = 43). Foster children's receptive vocabulary skills were assessed post‐intervention using the Peabody Picture Vocabulary Test, Third Edition, when children were between 36 and 60 months old. Children whose foster parents received ABC‐T demonstrated more advanced receptive vocabulary abilities than children whose foster parents received the control intervention. The positive effect of ABC‐T on foster children's receptive vocabulary was mediated by increases in foster parents’ sensitivity during parent–child interactions. Trial registration: ClinicalTrials.gov NCT01261806.     

Attention Biases to Threat Link Behavioral Inhibition to Social Withdrawal over Time in Very Young Children

Behaviorally inhibited children display a temperamental profile characterized by social withdrawal and anxious behaviors. Previous research, focused largely on adolescents, suggests that attention biases to threat may sustain high levels of behavioral inhibition (BI) over time, helping link early temperament to social outcomes. However, no prior studies examine the association between attention bias and BI before adolescence. The current study examined the interrelations among BI, attention biases to threat, and social withdrawal already manifest in early childhood. Children (N = 187, 83 Male, M _age  = 61.96 months) were characterized for BI in toddlerhood (24 & 36 months). At 5 years, they completed an attention bias task and concurrent social withdrawal was measured. As expected, BI in toddlerhood predicted high levels of social withdrawal in early childhood. However, this relation was moderated by attention bias. The BI-withdrawal association was only evident for children who displayed an attention bias toward threat. The data provide further support for models associating attention with socioemotional development and the later emergence of clinical anxiety.     

Positive emotional attention bias in young children with symptoms of ADHD

Children with attention-deficit/hyperactivity disorder (ADHD) often experience emotional dysregulation. Dysregulation can arise from heightened attention to emotional stimuli. Emotional attention biases are associated with a number of adverse socioemotional outcomes including reward sensitivity and externalizing behaviors. As reward sensitivity and externalizing behaviors are common in children with ADHD, the aim of the current study was to determine whether emotional attention biases are evident in young children with clinically significant ADHD symptoms. To test this, children with (n = 18) and without (n = 15) symptoms of ADHD were tested on a Dot Probe task. Provided recent evidence that emotional attention biases are attenuated by sleep, the task was performed before and after overnight sleep. Children with ADHD symptoms displayed positive, but not negative, attention biases at both time points, whereas typically developing children did not preferentially attend toward or away from positive or negative stimuli. Sleep did not alter attention biases in either group. Collectively, these results indicate that children with ADHD symptoms have stable, positive attention biases.     

EFFECTS OF SYSTEMATIC,RESPONSE-DEPENDENT FADING AND THINNING PROCEDURES ON THE MAINTENANCE OF CHILD-CHILD INTERACTION

Previous investigations of the social behavior of handicapped preschool children (Journal of Applied Behavior Analysis, 1974, 7 , 583–590; Journal of Applied Behavior Analysis, 1976, 9 , 31–40; Journal of Applied Behavior Analysis, 1977, 10 , 289–298) demonstrated that introduction of adult or peer confederate intervention agents produced substantial increases in levels of positive social behavior emitted by the subjects. In addition, it was observed that changes in rates of positive social behavior emitted by recipients of intervention tactics were accompanied by parallel changes in rates of positive social behavior emitted by interacting peers. However, with one limited exception, sudden removals of arranged intervention procedures were followed by immediate reductions in the levels of positive social behavior emitted by subjects and peers in each study. The current investigation was designed to examine the effects of response-dependent removal of intervention procedures on the positive behavior of three socially withdrawn preschool boys. Interactive effects on the social behavior of classroom peers who did not receive adult prompts and contingent attention events were also examined. A combination of withdrawal of treatment and multiple baseline procedures was employed. The three target subjects received fixed numbers of prompts and contingent attention events during Intervention I and Intervention II, Phase 1 conditions. During Intervention II, Phase 2 conditions, prompts and contingent attention events were reduced on a response-dependent basis for two subjects and on a response-independent basis for the third subject. The results suggest that: (a) the intervention procedures produced marked increases in positive social behavior emitted by each subject; (b) response-dependent fading and thinning, contrasted with response-independent tactics, maintained levels of positive social behavior equivalent to those observed during Intervention I and Intervention II, Phase 1 conditions; (c) changes in positive and negative behaviors emitted by peers paralleled changes in positive and negative behaviors emitted by each subject; and (d) no “spillover” of treatment effects was noted for subjects during periods in which they were not direct recipients of intervention procedures.     

Coherence and specificity of information-processing biases in depression and social phobia

Research has not resolved whether depression is associated with a distinct information-processing bias, whether the content of the information-processing bias in depression is specific to themes of loss and sadness, or whether biases are consistent across the tasks most commonly used to assess attention and memory processing. In the present study, participants diagnosed with major depression, social phobia, or no Axis I disorder, completed several information-processing tasks assessing attention and memory for sad, socially threatening, physically threatening, and positive stimuli. As predicted, depressed participants exhibited specific biases for stimuli connoting sadness; social phobic participants did not evidence such specificity for threat stimuli. It is important to note that the different measures of bias in memory and attention were not systematically intercorrelated. Implications for the study of cognitive bias in depression, and for cognitive theory more broadly, are discussed.     

Attention allocation in social anxiety during a speech

Cognitive models assume that social anxiety is associated with and maintained by biased information processing, leading to change in attention allocation, which can be measured by examining eye movement. However, little is known about the distribution of attention among positive, neutral and negative stimuli during a social task and the relative importance of positive versus negative biases in social anxiety. In this study, eye movement, subjective state anxiety and psychophysiology of individuals with high trait social anxiety (HSA) and low trait social anxiety (LSA) were measured during a speech task with a pre-recorded audience. The HSA group showed longer total fixation on negative stimuli and shorter total fixation on positive stimuli compared to the LSA group. We observed that the LSA group shifted attention away from negative stimuli, whereas the HSA group showed no differential attention allocation. The total duration of fixation on negative stimuli predicted subjective anxiety ratings. These results point to a negative bias as well as a lack of a positive bias in HSA individuals during social threat.     

Bias at the intersection of race and gender: Evidence from preschool‐aged children

There is ample evidence of racial and gender bias in young children, but thus far this evidence comes almost exclusively from children's responses to a single social category (either race or gender). Yet we are each simultaneously members of many social categories (including our race and gender). Among adults, racial and gender biases intersect: negative racial biases are expressed more strongly against males than females. Here, we consider the developmental origin of bias at the intersection of race and gender. Relying on both implicit and explicit measures, we assessed 4‐year‐old children's responses to target images of children who varied systematically in both race (Black and White) and gender (male and female). Children revealed a strong and consistent pro‐White bias. This racial bias was expressed more strongly for males than females: children's responses to Black boys were less positive than to Black girls, White boys or White girls. This outcome, which constitutes the earliest evidence of bias at the intersection of race and gender, underscores the importance of addressing bias in the first years of life.     

Age at Adoption from Institutional Care as a Window into the Lasting Effects of Early Experiences

One of the major questions of human development is how early experience impacts the course of development years later. Children adopted from institutional care experience varying levels of deprivation in their early life followed by qualitatively better care in an adoptive home, providing a unique opportunity to study the lasting effects of early deprivation and its timing. The effects of age at adoption from institutional care are discussed for multiple domains of social and behavioral development within the context of several prominent developmental hypotheses about the effects of early deprivation (cumulative effects, experience-expectant developmental programming, and experience-adaptive developmental programming). Age at adoption effects are detected in a majority of studies, particularly when children experienced global deprivation and were assessed in adolescence. For most outcomes, institutionalization beyond a certain age is associated with a step-like increase in risk for lasting social and behavioral problems, with the step occurring at an earlier age for children who experienced more severe levels of deprivation. Findings are discussed in terms of their concordance and discordance with our current hypotheses, and speculative explanations for the findings are offered.     

BEHAVIORAL ASSESSMENT FOR PEDIATRIC INTENSIVE CARE UNITS1

Two studies were conducted to analyze behaviors of staff and patients on a Pediatric Intensive Care Unit (PICU). In the first study, behavioral observation procedures were employed to assess patient state, physical position, affect, verbal behaviors, visual attention and activity engagement, and staff verbal behavior. On the average, one-third of the patients were judged to be conscious and alert but markedly nonengaged with their environment. In the second study, a member of the hospital staff provided alert patients with individual activities to determine whether a simple environmental manipulation could positively affect behavior of children in intensive care. Employing a reversal design, the activity intervention was found to increase attention and engagement and positive affect, and to decrease inappropriate behavior. Both studies demonstrate that behavioral assessment procedures can provide an empirical basis for designing PICU routines affecting children's psychosocial status, and, thus, complement current procedures designed to provide quality medical care.     

Promoting Mental Health in Disadvantaged Preschoolers: A Cluster Randomized Controlled Trial of Teacher Training Effects

The literature provides solid documentation of the negative consequences of poor psychosocial functioning and behavioral problems in early childhood. Children facing economic disadvantage are at higher risk for poor socio-emotional development and problem behaviors, which draws attention to the need for prevention targeted at this risk group. The aim of our study was to analyze the impact of an evidence-based teacher-training program, the Incredible Years Teacher Classroom Management (IY-TCM), on the behavior of economically disadvantaged Portuguese children. Participants were 1030 children aged 3–6 years, from 65 preschool classrooms selected for their high percentage of children from economically disadvantaged backgrounds. The study followed an experimental randomized controlled between-group design, with pre- and post-intervention assessments. Teachers in the experimental group attended the IY-TCM program, implemented in six monthly workshops, and four sessions of individual in-class support. Children outcomes were evaluated with the Preschool and Kindergarten Behavior Scales—2nd Edition (Social Skills and Problem Behavior scales). After the intervention, preschoolers in the IY-TCM classrooms showed more improvements in their social skills and more decreases in problem behavior. Children with lower levels of social skills (high risk) at pre-intervention and those coming from families in economic need showed greater improvements in social skills, but these effects were not observed for problem behavior. Results support the growing evidence of the effectiveness of the IY-TCM as a stand-alone, non-adapted program in a Portuguese cultural context, which can play a protective role in children’s lives and thus bridge the gap between children coming from different economic backgrounds.     

Atypical EEG power correlates with indiscriminately friendly behavior in internationally adopted children

While effects of institutional care on behavioral development have been studied extensively, effects on neural systems underlying these socioemotional and attention deficits are only beginning to be examined. The current study assessed electroencephalogram (EEG) power in 18-month-old internationally adopted, postinstitutionalized children (n = 37) and comparison groups of nonadopted children (n = 47) and children internationally adopted from foster care (n = 39). For their age, postinstitutionalized children had an atypical EEG power distribution, with relative power concentrated in lower frequency bands compared with nonadopted children. Both internationally adopted groups had lower absolute alpha power than nonadopted children. EEG power was not related to growth at adoption or to global cognitive ability. Atypical EEG power distribution at 18 months predicted indiscriminate friendliness and poorer inhibitory control at 36 months. Both postinstitutionalized and foster care children were more likely than nonadopted children to exhibit indiscriminate friendliness. Results are consistent with a cortical hypoactivation model of the effects of early deprivation on neural development and provide initial evidence associating this atypical EEG pattern with indiscriminate friendliness. Outcomes observed in the foster care children raise questions about the specificity of institutional rearing as a risk factor and emphasize the need for broader consideration of the effects of early deprivation and disruptions in care.