Are there biological programming effects for psychological development? Findings from a study of Romanian adoptees

Associations between experiences and outcomes could be due to (a) continuation of adversity or (b) organismic changes, including experience-expectant and experience-adaptive developmental programming. The adoption into British families of children who had been reared in profoundly depriving institutions in Romania presented an opportunity to test mechanisms. Romanian children reared from infancy in very depriving institutions for periods up to 42 months were compared with 52 nondeprived UK-born children placed into adoptive families before the age of 6 months. The results at 6 years of age showed substantial normal cognitive and social functioning after the provision of family rearing but also major persistent deficits in a substantial minority. The pattern of findings suggests some form of early biological programming or neural damage stemming from institutional deprivation, but the heterogeneity in outcome indicates that the effects are not deterministic.     

Early Institutionalization: Neurobiological Consequences and Genetic Modifiers

Children raised in the profound deprivation associated with institutionalization are at elevated risk for negative outcomes across a host of social and cognitive domains. This risk appears to be mitigated by early foster care or adoption into a family setting. Although pervasive developmental problems have been noted in a substantial proportion of previously institutionalized children, marked variation exists in the nature and severity of these deficits. Increasing evidence suggests that institutional deprivation impacts the developing brain, potentially underlying the wide range of outcomes with which it is associated. In the current review we examine the neural consequences of institutionalization and genetic factors associated with differences in outcome in an effort to characterize the consequences of early deprivation at a neurobiological level. Although the effects of institutional deprivation have been studied for more than 50 years much remains unanswered regarding the pathways through which institutionalization impacts child development. Through a more complete and nuanced assessment of the neural correlates of exposure and recovery as well as a better understanding of the individual factors involved we will be better able to delineate the impact of early adversity in the setting of severe social deprivation.     

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.     

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.     

Behavior Problems in Children Adopted from Psychosocially Depriving Institutions

Behavior problems were investigated in 342 6- to 18-year-old children adopted from psychosocially depriving Russian institutions that provided adequate physical resources but not consistent, responsive caregiving. Results indicated that attention and externalizing problems were the most prevalent types of behavior problems in the sample as a whole. Behavior problem rates increased with age at adoption, such that children adopted at 18 months or older had higher rates than never-institutionalized children but younger-adopted children did not. There was a stronger association between age at adoption and behavior problems during adolescence than at younger ages at assessment. Children adopted from psychosocially depriving institutions had lower behavior problem rates than children adopted from severely depriving Romanian institutions in the 1990s. The implications of these results are that early psychosocial deprivation is associated with behavior problems, children exposed to prolonged early deprivation may be especially vulnerable to the developmental stresses of adolescence, and severe institutional deprivation is associated with a higher percentage of behavior problems after a shorter duration of exposure.     

The effects of early foster care intervention on attention biases in previously institutionalized children in Romania

Children raised in institutions experience psychosocial deprivation that can negatively impact attention skills and emotion regulation, which subsequently may influence behavioral regulation and social relationships. The current study examined visual attention biases in 8‐year‐old children who were part of the Bucharest Early Intervention Project (BEIP). Relations among attention biases and concurrent social outcomes were also investigated. In early childhood, 136 children abandoned at birth or shortly thereafter into institutional care were randomized to receive a high‐quality foster care intervention or care‐as‐usual within the context of the Bucharest Early Intervention Project (BEIP). At 8 years of age, 50 care‐as‐usual, 55 foster care, and 52 community controls performed a behavioral dot‐probe task, and indices of attention biases to threat and positive stimuli were calculated. Concurrent data on social behavior were collected. Children placed into the foster care intervention had a significant attention bias toward positive stimuli, while children who received care‐as‐usual had a significant bias toward threat. Children in the foster care intervention had a significantly larger positive bias when compared to the care‐as‐usual group. A positive bias was related to more social engagement, more prosocial behavior, less externalizing disorders, and less emotionally withdrawn behavior. The magnitude of positive bias was predicted by age of placement into foster care among children with a history of institutionalization. An attention bias towards positive stimuli was associated with reduced risk for behavioral problems amongst children who experienced early psychosocial deprivation. Research assessing attention biases in children experiencing early environmental stress may refine our understanding of the mechanisms underlying risk for later psychiatric and social disorders and inform prevention efforts.     

Biological perspectives on the effects of early psychosocial experience

There is much current interest in how adverse experiences early in life might affect certain elements of physiological, behavioral, and psychological functioning across the lifespan. Recent conceptual frameworks for studying the effects of early experience have involved constructs such as experience-expectant, experience-dependent, and experience-adaptive plasticity. The latter construct is related to comparative models of developmental programming which posit the persistence of biological adjustments to the early caregiving environment. We briefly review such models and their translational implications. We then turn to human development and focus on the effects of large changes in children’s life courses as tests of hypotheses related to early experience effects. In particular, the effect of early institutionalization on children’s brain and behavioral development after changes to adoptive families or foster care is used as an example of a research area in which programming hypotheses have been proposed.     

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.     

Institutional care and iron deficiency increase ADHD symptomology and lower IQ 2.5–5 years post‐adoption

Increased ADHD symptomology and lower IQ have been reported in internationally adopted (IA) children compared to non‐adopted peers (Hostinar, Stellern, Schaefer, Carlson & Gunnar, 2012; Kreppner, O'Connor & Rutter, 2001). However, it is unclear whether these outcomes are due to institutional deprivation specifically or to co‐occurring micronutrient deficiencies that disrupt brain development (Fuglestad, Rao & Georgieff, 2008b). In this study, IA children were compared to children raised in their biological families to examine differences in ADHD symptomology and IQ 2.5–5 years post‐adoption and to assess the contributions of iron deficiency (ID) and duration of deprivation to these cognitive outcomes. ADHD symptoms (parent‐ and experimenter‐reported) and IQ were evaluated in 88 IA (M = 62.1 months, SD = 2.4) and 35 non‐adopted children (M = 61.4 months, SD = 1.6). IA children were assessed 29–64 months post‐adoption (M = 41.9 months, SD = 10.2). ID was assessed during the initial post‐adoption medical visit in 69 children, and children were classified into four groups by iron status, ranging from normal to ID anemia (most severe). IA children had greater ADHD symptomology, p < .01, and lower IQ, p = .001, than non‐adopted children. Within the IA group, children with more severe ID at adoption had greater ADHD symptomology, r(69) = 0.40, p = .001, and lower IQ, r(68) = −0.28, p < .05. Duration of institutional care was positively correlated with ADHD symptoms, r(86) = .28, p < .01, but not IQ, r(85) = −.08, p = .52. Longitudinal results indicate improvement in IQ from 12 months post‐adoption to age 5 for children with greater ID severity at adoption and longer duration of institutional care but no improvement in ADHD symptoms. These results signify continuing effects of early deprivation and ID on ADHD symptoms and IQ years after adoption. A video abstract of this article can be viewed at http://www.youtube.com/watch?v=vUFDAS3DD1c     

Inattention/Overactivity Following Early Severe Institutional Deprivation: Presentation and Associations in Early Adolescence

The current study examined the persistence and phenotypic presentation of inattention/overactivity (I/O) into early adolescence, in a sample of institution reared (IR) children adopted from Romania before the age of 43 months. Total sample comprised 144 IR and 21 non-IR Romanian adoptees, and a comparison group of 52 within-UK adoptees, assessed at ages 6 and 11 years. I/O was rated using Rutter Scales completed by parents and teachers. I/O continued to be strongly associated with institutional deprivation, with continuities between ages 6 and 11 outcomes. There were higher rates of deprivation-related I/O in boys than girls, and I/O was strongly associated with conduct problems, disinhibited attachment and executive function but not IQ more generally, independently of gender. Deprivation-related I/O shares many common features with ADHD, despite its different etiology and putative developmental mechanisms. I/O is a persistent domain of impairment following early institutional deprivation of 6 months or more, suggesting there may be a possible pathway to impairment through some form of neuro-developmental programming during critical periods of early development.     

ADHD Symptoms in Post-Institutionalized Children Are Partially Mediated by Altered Frontal EEG Asymmetry

Individual differences in the propensity for left versus right frontal electroencephalogram (EEG) asymmetry may underlie differences in approach/withdrawal tendencies and mental health deficits. Growing evidence suggests that early life adversity may shape brain development and contribute to the emergence of mental health problems. The present study examined frontal EEG asymmetry (FEA) following the transition to family care in children adopted internationally from institutional care settings between 15 and 36 months of age (N = 82; 46 female, 36 male). Two comparison groups were included: an international adoption control consisting of children adopted from foster care with little to no institutional deprivation (N = 45; 17 female, 28 male) and a post-adoption condition control consisting of children reared in birth families of the same education and income as the adoptive families (N = 48; 23 female, 25 male). Consistent with evidence of greater approach and impulsivity-related behavior problems in post-institutionalized (PI) children, PI status was associated with greater left FEA than found in the other two groups. In addition, left FEA served as a mediator between institutionalization and age 5 ADHD symptoms for girls. Age at adoption and other preadoption factors were examined with results suggesting that earlier adoption into a supportive family resulted in a more typical pattern of brain functioning. Findings support the idea that the capacity of brain activity to evidence typical functioning following perturbation may differ in relation to the timing of intervention and suggest that the earlier the intervention of adoption, the better.     

Language difficulties in children adopted internationally: Neuropsychological and functional neural correlates

Children who have experienced deprivation as a result of orphanage care during early development are at increased risk for a number of cognitive, emotional, and social difficulties (MacLean, 2003). This study examined the neuropsychological and behavioral profile of internationally adopted children with language difficulties, one of the most common cognitive challenges (Behen et al., 2008). In addition to neuropsychological testing, fMRI was utilized to examine activation patterns during expressive fluency and receptive language tasks. In comparison to internationally adopted children without language difficulties and nonadopted controls, participants with language difficulty had worse performance on tasks of verbal memory and reasoning, academic skills, and working memory. Behaviorally, all internationally adopted participants, regardless of language ability, had more parent-reported hyperactivity and impulsivity compared with controls. The fMRI tasks revealed reduced activation in traditional language areas in participants with language difficulty. The impact of early adverse experience on later development is discussed.     

Potential consequences of abandonment in preschool-age: Neuropsychological findings in institutionalized children

Objective: Several longitudinal studies had shown that early deprivation and institutionalization during the first six months of life affects the emotional, cognitive, social and neurophysiologic development. Nevertheless, our understanding of possible similar effects of delayed institutionalization, in preschool-age remains unclear to this day. The goal of this study is to evaluate the cognitive performance of institutionalized children with history of preschool-age physical abandonment. Method: 18 male institutionalized children with history of abandonment during the preschool-age (2-5 years old) and comparison group matched by age, handedness, gender, educational and socioeconomic level were tested on multiple tasks of attention, memory and executive functions. Results: We found a cognitive impairment in the institutionalized children in several measures of attention, memory and executive functions. This is the first report of cognitive impairment related to late abandonment and institutionalization effects (after 2 years old), extending the already known effects on early institutionalization. Conclusions: This preliminary study suggests that environmental factors including abandonment and institutional care, can affect not only the infancy period, but also the preschool period providing new insights into our understanding of neurocognitive development.     

Prolonged institutional rearing is associated with atypically large amygdala volume and difficulties in emotion regulation

Early adversity, for example poor caregiving, can have profound effects on emotional development. Orphanage rearing, even in the best circumstances, lies outside of the bounds of a species-typical caregiving environment. The long-term effects of this early adversity on the neurobiological development associated with socio-emotional behaviors are not well understood. Seventy-eight children, who include those who have experienced orphanage care and a comparison group, were assessed. Magnetic resonance imaging (MRI) was used to measure volumes of whole brain and limbic structures (e.g. amygdala, hippocampus). Emotion regulation was assessed with an emotional go-nogo paradigm, and anxiety and internalizing behaviors were assessed using the Screen for Child Anxiety Related Emotional Disorders, the Child Behavior Checklist, and a structured clinical interview. Late adoption was associated with larger corrected amygdala volumes, poorer emotion regulation, and increased anxiety. Although more than 50% of the children who experienced orphanage rearing met criteria for a psychiatric disorder, with a third having an anxiety disorder, the group differences observed in amygdala volume were not driven by the presence of an anxiety disorder. The findings are consistent with previous reports describing negative effects of prolonged orphanage care on emotional behavior and with animal models that show long-term changes in the amygdala and emotional behavior following early postnatal stress. These changes in limbic circuitry may underlie residual emotional and social problems experienced by children who have been internationally adopted.     

Normality and impairment following profound early institutional deprivation: a longitudinal follow-up into early adolescence

Longitudinal analyses on normal versus impaired functioning across 7 domains were conducted in children who had experienced profound institutional deprivation up to the age of 42 months and were adopted from Romania into U.K. families. Comparisons were made with noninstitutionalized children adopted from Romania and with nondeprived within-U.K. adoptees placed before the age of 6 months. Specifically, the validity of the assessment, the degree of continuity and change in levels of functioning from 6 to 11 years, and the factors in the pre- and postadoption environment accounting for heterogeneity in outcome were examined. Pervasive impairment was significantly raised in children experiencing institutional deprivation for > or =6 months of life, with a minority within this group showing no impairment. There was no additional significant effect of duration of deprivation beyond the 6-month cutoff, and few other predictors explained outcome. The pattern of normality/impairment was mainly established by 6 years of age, with considerable continuity at the individual level between 6 and 11 years. The findings are discussed in terms of the possibility of a sensitive period for development.     

Early family adversity,stability and consistency of institutional care and infant cognitive,language and motor development across the first six months of institutionalization

This study extends research on the effects of institutionalization—by examining the trajectories of cognitive, language and motor development of 64 Portuguese infants and toddlers across the first six months of institutionalization, while determining whether pre-institutional adversities and the stability and consistency of institutional care predict children’s development. At time of enrollment, 23.4%, 32.8% and 31.3% of the children were moderately to severely delayed, respectively, in their cognitive, linguistic and motor functioning. Developmental problems persisted after six months of institutionalization. The accumulation of early pre-institutional adversities predicted cognitive and motor limitations at admission to the institutions, but not variation in subsequent development. The stability and consistency of institutional care also failed to predict developmental growth and change. Children who had never lived with their families of origin showed a better language development at enrollment than their counterparts who had lived with their families of origin before institutionalization. Such advantage was followed by a deceleration in language growth after six months of institutional placement. Results are discussed in terms of short- vs. longer-term effects of institutionalization.     

早期经验对儿童心理发展的影响

儿童早期经验包括产前环境、出生时身体状况、出生后家庭养育和学前教育经历等,这些方面对儿童心理能力发展有重要而长期的影响。该文基于国外新近开展的大型纵向研究,对胎儿期母亲的情绪行为特征,出生状况,出生后母亲工作状况,父亲教养行为,学前教育状况等对儿童认知能力、学业成就、社会行为等的预测作用,以及种族、性别、家庭经济地位等背景因素在两者之间的调节作用进行了介绍,最后对我国设计和开展相关研究提出了建议。     

The role of learning in social development: Illustrations from neglected children

Children who experience early caregiving neglect are very likely to have problems developing and maintaining relationships and regulating their social behavior. One of the earliest manifestations of this problem is reflected in indiscriminate behavior, a phenomenon where young children do not show normative wariness of strangers or use familiar adults as sources of security. To better understand the developmental mechanisms underlying the emergence of these problems, this study examined whether institutionally reared children, who experienced early social neglect, had difficulty associating motivational significance to visual stimuli. Pairing stimuli with motivational significance is presumably one of the associative learning processes involved in establishing discriminate or selective relationships with others. We found that early experiences of neglectful caregiving were associated with difficulties in acquiring such associations, and that delays in this developmental skill were related to children's social difficulties. These data suggest a way in which early social learning experiences may impact the development of processes underlying emotional development.     

Differential expression of social dominance as a function of age and maltreatment experience

Recent perspectives on social dominance in normative populations have suggested a developmental progression from using primarily coercive strategies to incorporation of more socially competent strategies to attain material and social resources. Parental influences on the resource control strategies children use have been proposed but not investigated empirically. The present study examined age- and gender-related differences in dominance strategies in 470 children from high-risk neighborhoods who were between 6 and 13 years of age, approximately half of whom had experienced maltreatment. A Q-sort measure of social dominance was developed and received preliminary support. Consistent with predictions from resource control theory, age-related differences in dominance-related behavior were demonstrated in both nonmaltreated and maltreated children. Maltreated children were more likely than nonmaltreated children to be identified as dominant bullies at any age. Dominance and bullying were not more likely to be associated for children who had experienced physical and sexual abuse relative to those who were neglected or emotionally maltreated. Results are discussed in terms of the influence of maltreatment on the social development of children, and intervention approaches for limiting these deleterious effects are recommended.     

The Confluence of Adverse Early Experience and Puberty on the Cortisol Awakening Response

Associations between early deprivation/neglect in the form of institutional care with the cortisol awakening response (CAR) were examined as a function of pubertal status among 12- and 13-year-old post-institutionalized youth. CARs indexed hypothalamic-pituitary-adrenocortical reactivity. Post-institutionalized youth were compared to youth adopted internationally from foster care (adoption control) and to nonadopted youth reared in families comparable in parental education and income to the adoptive families. Post-institutionalized youth exhibited a blunted CAR if they were at earlier but not if they were at later stages of puberty. Similarly, for both groups of internationally adopted youth combined, earlier but not later stages of puberty were associated with more blunted CARs at higher but not lower levels of parent-reported pre-adoption physical and social neglect.