May 11, 2013
Early Neglect and Child Development: Randomized trail compares children in institutions with those in foster care Summarized by Arthur Becker-Weidman, PhD Severe neglect and institutional care cause significant difficulties in attachment, biology, cognitive functioning including executive and neuropsychological functions, and behavioral and emotional regulation. Studies of children in Romanian orphanages and other settings have demonstrated the pervasive and negative impact of such neglect on various domains of child development. Those of us who work with such children know the complexities of helping families with these children. Their difficulties may include disturbed patterns of attachment, sensory-integration dysfunction, various neuropsychological impairments, mental health issues, and problems with emotional and behavioral regulation. These children are extremely challenging to work with and their families need comprehensive and supportive treatments. The Bucharest study, led by Charles Nelson, III, Nathan Fox, and Charles Zeanah, Jr., is a randomized trial comparing the emotional and physical well being of institutionalized children with those place in foster homes. The study involved 136 children in orphanages in Romania. The average age was 22 month, ranging from 6 to 31 months of age. All children selected were free of neurological, genetic, and other birth defects based on a study-team pediatrician's examination. The children selected then has a series of baseline physical and psychological assessment. Half the children were randomly assigned to foster care while the other half remained in the institution. The children placed in foster care were placed in homes that had been recruited, trained, financed, and maintained by the study team. This would be considered high quality foster care. The study team also recruited a third group of typically developing children who lived with their birth families and who had never been institutionalized. The study went on for ten years. One important finding that has significance not only for institutionalized children, but for all children who experience maltreatment is that there sensitive periods during which environmental influences are particularly powerful. The study found that the average IQ of the institutionalized children, measured at thirty, forty, and fifty-two months was in the low to middle 70's while it was ten points higher for the children in foster care. In other words, after only between eight and thirty months longer in an insitutional setting, there was about a 12.5% drop in IQ. The average IQ for the group of children never institutionalized was 100; or about 20% than the children in foster care. Or, to put it differently, about two years in an institution is associated with a 30% lower IQ. The sensitive period seems to be the first two years. The study found that a child placed in a home before two years of age had a significantly larger gain in IQ than a child placed in foster care after two years of age. The study measured attachment and found that the institutionalized children displayed incompletely formed and aberrant relationships with care-givers. However children place in foster care, at 42 months of age (after an average of 20 months in foster care) displayed major improvements in making emotional attachments. About half the children in foster care demonstrated secure attachments while only eighteen percent of the child in institutions demonstrated secure attachments. Sixty-five percent of the children never placed in institutions displaced secure attachments. This seems to demonstrate the capacity of healing relationships to help remedy these significant early deficits. However, as with IQ, children placed in foster care before two years of age were more likely to form secure attachments when compared with children placed after two years of age. Foster care had a major influence on levels of anxiety and depression; reducing their incidence by half. The more secure the attachment between the child and foster parent, the greater probability that the child's symptoms would be reduced. The study examined brain activity using an EEG. They found that infants in institutions has significant reductions in alpha and heightened theta waves, which they stated reflect delayed brain maturation. When measured eight years later they found that children placed in foster care before two years of age showed no difference in EEG when compared with children never in an institution. Children who remained in the institution and those placed in foster care after two years of age showed EEG patterns reflecting delayed brain maturation. Institutionalized children had smaller brain volumes. Finally they examined telomeres, regions at the ends of chromosomes that provide protection from the stresses of cell division and which are shorter in people who have experienced extreme psychological distress than in those who have not experienced such stresses. Children who spent any time in an institution had shorter telomeres than those who had not. REFERENCES Almas, A., et. al., (2012). Effects of Early Intervention and the Moderating Effects of Brain Activity on Institutionalized Children's Social Skills at Age 8. Proceeding of the National Academy of Sciences, 109 (2), 17,228-17,231. Nelson, C., (2007). Cognitive Recovery in Socially Deprived Young Children: The Bucharest Early Intervention Project. Science 318, 1937-1940. Scientific American (2013). How Adversity Affects Young Children www.ScientificAmerican.com/apr2013/orphans, accessed May 11, 2013.