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Long-term effects of institutional rearing, foster care, and brain activity on memory and executive functioning.

ABSTRACT: Children experiencing psychosocial deprivation as a result of early institutional rearing demonstrate many difficulties with memory and executive functioning (EF). To date, there is scant evidence that foster care placement remediates these difficulties during childhood. The current study examined longitudinal trajectories of memory and EF from childhood to adolescence in the Bucharest Early Intervention Project, a randomized controlled trial of foster care for institutionally reared children. We demonstrate that both ever- and never-institutionalized children show age-related improvements on several measures of memory and EF from age 8 to 16. Distinct patterns were observed for different domains of functioning: (i) Early-emerging disparities in attention and short-term visual memory, as well as spatial planning and problem solving, between ever- and never-institutionalized children persisted through adolescence; (ii) the gap in spatial working memory between ever- and never-institutionalized children widened by adolescence; and (iii) early difficulties in visual-spatial memory and new learning among children in foster care were mitigated by adolescence. Secondary analyses showed that higher resting EEG alpha power at age 8 predicted better EF outcomes in several domains at age 8, 12, and 16. These results suggest that early institutional rearing has enduring consequences for the development of memory and EF, with the possibility of catch-up among previously institutionalized children who start out with higher levels of problems. Finally, interindividual differences in brain activity relate to memory and EF across ages, thus highlighting one potential biological pathway through which early neglect impacts long-term cognitive functioning.

SUBMITTER: Wade M

PROVIDER: S-EPMC6358707 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Long-term effects of institutional rearing, foster care, and brain activity on memory and executive functioning.

Wade Mark M Fox Nathan A NA Zeanah Charles H CH Nelson Charles A CA

Proceedings of the National Academy of Sciences of the United States of America 20190114 5

Children experiencing psychosocial deprivation as a result of early institutional rearing demonstrate many difficulties with memory and executive functioning (EF). To date, there is scant evidence that foster care placement remediates these difficulties during childhood. The current study examined longitudinal trajectories of memory and EF from childhood to adolescence in the Bucharest Early Intervention Project, a randomized controlled trial of foster care for institutionally reared children. W ...[more]

PMID: 30642973

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Project description:ImportanceIt is unclear whether early institutional rearing is associated with more problematic trajectories of psychopathology from childhood to adolescence and whether assignment to foster care mitigates this risk.ObjectivesTo examine trajectories of latent psychopathology factors-general (P), internalizing (INT), and externalizing (EXT)-among children reared in institutions and to evaluate whether randomization to foster care is associated with reductions in psychopathology from middle childhood through adolescence.Design, setting, and participantsThis longitudinal, intent-to-treat randomized clinical trial was conducted in Bucharest, Romania, where children residing in 6 institutions underwent baseline testing and were then randomly assigned to a care as usual group (CAUG) or a foster care group (FCG). A matched sample of a never-institutionalized group (NIG) was recruited to serve as a comparison group. The study commenced in April 2001, and the most recent (age 16 years) follow-up started in January 2015 and is ongoing.InterventionInstitutionally reared children randomized to high-quality foster homes.Main outcomes and measuresPsychopathology was measured using the MacArthur Health and Behavior Questionnaire. Teachers and/or caregivers reported on symptoms of psychopathology in several domains.ResultsA total of 220 children (50.0% female; 119 ever institutionalized) were included in the analysis at the mean ages of 8, 12, and 16 years. A latent bifactor model with general (P) and specific internalizing (INT) and externalizing (EXT) factors offered a good fit to the data. At age 8 years, CAUG (mean, 0.41; 95% CI, 0.17-0.67) and FCG (mean, 0.30; 95% CI, 0.04-0.53) had higher P than NIG (mean, -0.40; 95% CI, -0.56 to -0.18). By age 16 years, FCG (mean, 0.07; 95% CI, -0.18 to 0.29) had lower P than CAUG (mean, 0.37; 95% CI, 0.13-0.60). This effect was likely driven by modest declines in P from age 8 years to age 16 years among FCG (slope, -0.12; 95% CI, -0.26 to 0.04) compared with CAUG, who remained stably high over this period (slope, -0.02; 95% CI, -0.19 to 0.14). Moreover, CAUG and FCG showed increasing divergence in EXT over time, such that FCG (mean, -0.30; 95% CI, -0.58 to -0.02) had fewer problems than CAUG (mean, 0.05; 95% CI, -0.25 to 0.36) by age 16 years. No INT differences were observed.Conclusions and relevanceInstitutionalization increases transdiagnostic vulnerability to psychopathology from childhood to adolescence, a period of significant social and biological change. Early assignment to foster care partially mitigates this risk, thus highlighting the importance of social enrichment in buffering the effects of severe early neglect on trajectories of psychopathology.Trial registrationClinicalTrials.gov Identifier: NCT00747396.

Project description:BackgroundEarly social deprivation can negatively affect domains of functioning. We examined psychopathology at age 12 years in a cohort of Romanian children who had been abandoned at birth and placed into institutional care, then assigned either to be placed in foster care or to care as usual.MethodsWe used follow-up data from the Bucharest Early Intervention Project (BEIP), a randomised controlled trial of abandoned children in all six institutions for young children in Bucharest, Romania. In the initial trial, 136 children, enrolled between ages 6-31 months, were randomly assigned to either care as usual or placement in foster care. In this study we followed up these children at age 12 years to assess psychiatric symptoms using the Diagnostic Interview Schedule for Children (4th edition; DISC-IV). We also recruited Romanian children who had never been placed in an institution from paediatric clinics and schools in Bucharest as a comparator group who had never been placed in an institution. The primary outcome measure was symptom counts assessed through DISC-IV scores for three domains of psychopathology: internalising symptoms, externalising symptoms, and attention-deficit hyperactivity disorder (ADHD). We compared mean DISC-IV scores between trial participants and comparators who had never been placed in an institution, and those assigned to care as usual or foster care. Analyses were done by modified intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00747396.FindingsWe followed up 110 children from the BEIP trial between Jan 27, 2011, and April 11, 2014, and 49 children as comparators who had never been placed in an institution. The 110 children who had ever been placed in an institution had higher symptom counts for internalising disorders (mean 0·93 [SD 1·68] vs 0·45 [0·84], difference 0·48 [95% CI 0·14-0·82]; p=0·0127), externalising disorders (2·31 [2·86] vs 0·65 [1·33], difference 1·66 [1·06-2·25]; p<0·0001), and ADHD (4·00 [5·01] vs 0·71 [1·85], difference 3·29 [95% CI 2·39-4·18]; p<0·0001) than did children who had never been placed in an institution. Compared with 55 children randomly assigned to receive care as usual, the 55 children in the foster-care group had fewer externalising symptoms (mean 2·89 [SD 3·00] for care as usual vs 1·73 [2·61] for foster care, difference 1·16 [95% CI 0·11 to 2·22]; p=0·0255), but symptom counts for internalising disorders (mean 1·00 [1·59] for care as usual vs 0·85 [1·78] for foster care, difference 0·15 [-0·35 to 0·65]; p=0·5681) and ADHD (mean 3·76 [4·61] for care as usual vs 4·24 [5·41] for foster care, difference -0·47 [-2·15 to 1·20; p=0·5790) did not differ. In further analyses, symptom scores substantially differed by stability of foster-care placement.InterpretationEarly foster care slightly reduced the risk of psychopathology in children who had been living in institutions, but long-term stability of foster-care placements is an important predictor of psychopathology in early adolescence.FundingNational Institute of Mental Health and the John D and Catherine T MacArthur Foundation.

Project description:OBJECTIVES:To examine catechol-O-methyltransferase (COMT) rs4680 genotypes as moderators of the effects of parenting style on postinjury changes in parent behavior ratings of executive dysfunction following moderate to severe early childhood traumatic brain injury. SETTING:Research was conducted in an outpatient setting. PARTICIPANTS:Participants included children admitted to hospital with moderate to severe traumatic brain injury (n = 55) or orthopedic injuries (n = 70) between ages 3 and 7 years. DESIGN:Prospective cohort followed over 7 years postinjury. MAIN MEASURES:Parenting Practices Questionnaire and the Behavior Rating Inventory of Executive Functioning obtained at baseline, 6, 12, and 18 months, and 3.5 and 6.8 years postinjury. DNA was collected from saliva samples, purified using the Oragene (DNA Genotek, Ottawa, Ontario, Canada) OG-500 self-collection tubes, and analyzed using TaqMan (Applied Biosystems, Thermo Fisher Scientific, Waltham, Massachusetts) assay protocols to identify the COMT rs4680 polymorphism. RESULTS:Linear mixed models revealed a significant genotype × parenting style × time interaction (F = 5.72, P = .02), which suggested that the adverse effects of authoritarian parenting on postinjury development of executive functioning were buffered by the presence of the COMT AA genotype (lower enzyme activity, higher dopamine levels). There were no significant associations of executive functioning with the interaction between genotype and authoritative or permissive parenting ratings. CONCLUSION:The lower activity COMT rs4680 genotype may buffer the negative effect of authoritarian parenting on long-term executive functioning following injury in early childhood. The findings provide preliminary evidence for associations of parenting style with executive dysfunction in children and for a complex interplay of genetic and environmental factors as contributors to decreases in these problems after traumatic injuries in children. Further investigation is warranted to understand the interplay among genetic and environmental factors related to recovery after traumatic brain injury in children.

Dataset Information

Long-term effects of institutional rearing, foster care, and brain activity on memory and executive functioning.

Publications

Long-term effects of institutional rearing, foster care, and brain activity on memory and executive functioning.

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