Functioning in Children with Early Psychosocial Deprivation - Annotated Bibliography Example

Functioning in Children with Early Psychosocial Deprivation Almas, A.N., Degnan, K.A., Radulescu, A., Nelson III, C.A., Zeanah, C.H., and Fox, N.A. (2012). Effects of early interventions and the moderating effects of brain activity on institutionalized children’s social skills at age 8. Proceedings of the National Academy of Sciences of the United States of America, 109 (2). doi: 10.1073/pnas.1121256109 Almas et al (2012) studied 44 children who had been institutionalized in a Romanian setting to ascertain whether they had different social skills to those still in institutions and those living in a family home who had never been institutionalized. Each child was assessed at age 42 months for brain electrical activity (alpha power) and their attachment to their primary caregiver. At 8 years, these two measures were taken again and teachers were asked to give a rating of their social skills. Teachers rated children who had been taken out of institutions before the age of 20 months having social skills no different from never-institutionalized children, and both these groups had much higher social skill levels than those placed into foster care after the age of 20 months and those who were still in institutions. Additionally, attachment security was rated lower for these latter two groups. This suggests that low levels of interactions with a typical parent or guardian figure may have an effect on social development later in life due to the fact that these individuals have lower levels of psychosocial interaction. This effect is moderated by electroencephalogram alpha power as measured at age 8, but still presents an interesting problem. It should be noted that the sample size is fairly low and is limited to those in the Bucharest Early Intervention Project so results may not be generalizable to other populations. Beckett, C., Maughan, B., Rutter, M., Castle, J., Colvert, E., Groothues, C., Kreppner, J., Stevens, S., O’Connor, T.G., & Sonuga-Barke, E. J. S. (2006). Do the effects of early severe deprivation on cognition persist into early adolescence? Findings from the English and Romanian adoptees study. Child Development, 77(3), 696-711. doi: 0009-3920/2006/7703-0013 Beckett et al (2006) examined the differences between cognitive outcomes at age 11 of those adopted in the UK from either Romanian institutions or UK institutions. 131 Romanian children were surveyed and compared with 50 UK children using various measures. McCarthy Scales of Children’s Abilities was used at age 6 and the Wechsler Intelligence Scale for Children was used at age 11 and different demographic information was gathered. It was shown that those who arrived in the UK from Romania showed no significant differences if under 6 months on arrival, with 15 points being deducted for those over 6 months. No differences could be found between those who arrived in the range of 6 to 42 months. All these results suggest that there may be some level of ongoing problems in those arriving from Romanian institutions and the study suggests that this is because of the nature of these institutes. For example, there are less carers per child and there may be a level of postnatal malnutrition. These are all psychobiological factors that lead to an ongoing cognitive deficit in children. It must be noted that there is an uneven sample size between the UK and Romanian adoptees which may cause some bias. Behen, M., Helder, E., Rothermel, R., Solomon, K., & Behen, M., Helder, E., Rothermel, R., Solomon, K., & Chugani, H. (2008). Incidence of specific absolute neurocognitive impairment in globally intact children with histories of early severe deprivation. Child Neuropsychology, 14(5), 453-469. doi: 10.1080/09297040802244136 Behen et al (2008) examined 85 children who were raised from birth in orphanages, with 54 of these being considered globally intact for the purpose of the study. 46% of these children showed some absolute impairment in one important aspect of functioning – these children were statistically more likely to be those who had spent a longer time in the orphanage. It was suggested that there was a consistant link between incidence of impairment and the number of domains affected in the child and how long the individual had spent in the orphanage. There did not seem to be any evidence of “catch up” in these children after leaving the orphanage, which provides evidence that psychosocial deprivation that comes from a lack of a traditional family unit has a long-term effect on children that can never be erased. It must be noted that the sample size for this study is rather small. However, the participants were from orphanages in a number of different areas, including Eastern Europe, Northern Asia and South Asia, which means that the results may be generalizable on a global scale if replicated by other larger studies. Castle, J., Groothues, C., Bredenkamp, D., Beckett, C., O’Connor, T., Rutter, M. and the E.R.A. study team. (1999). Effects of qualities of early institutional care on cognitive attainment. American Journal of Orthopsychiatry, 69, 424-437. Castle et al (1999) suggested that adoption of children from poor quality Romanian institutions could be considered a natural experiment as they provide a low psychosocial interaction level and could show whether institutionalization in this type of scenario caused deficits in functioning in later life. It was found that children who had a low IQ at the age of six years were more likely to have been institutionalized for a longer period of time. This was compared with standard malnutrition in early years, which was still found to have an effect but psychosocial deprivation was found to be more statistically significant. It is suggested throughout that this type of institution does not provide an individualized care scenario and therefore could lead to marked effects on children in later life. This adds to the theory that early stimulation from psychosocial interactions is important for development. Ellis, H., Fisher, P.A., & Zaharie, S. (2004). Predictors of disruptive behavior, developmental delays, anxiety, and affective symptomatology among institutionally reared Romanian Children. Journal of the American Academy of Child and Adolescent Psychiatry, 43 (10), 1283-92. DOI: 10.1097/01.chi.0000136562.24085.160 Ellis et al (2004) completed another study on Romanian children who had been placed in institutions. Like other studies, the study aimed to show correlation between duration of institutionalization and mental and physical outcomes in later life, but also included age at abandonment as a variable. The children measured were 2-6 years of age and were studied by caregivers. They were not compared against non-institutionalized children, but age at abandonment and time spent in orphanages was shown to be linked to developmental delays, anxiety and physical growth delays. Additionally, children who spent longer periods of time in institutions were found to have higher rates of psychiatric symptoms which may continue into later life. Although the study size was small and there was no non-institutionalized control, there is still evidence that children who spent long amounts of time without psychosocial stimulation in this type of institution are more likely to have cognitive deficits in later life and may show behavioural problems. Additionally, this is one of the only studies to suggest that there may be anxiety or other psychiatric symptoms linked to this lack of psychosocial development. Fox, S. E., Levitt, P., & Nelson, C. A. (2010). How the timing and quality of early experiences influence the development of brain architecture. Child Development, 81(1), 28-40. Fox et al (2010) considered a conceptual framework to show the links between brain architecture, behavioural development and early life events. This paper explores how genetics plays an early role in development, but that later experience interacts with these genetics and plays a role in modifying the structure and function in the brain. This paper is more focused on the neurological basis for the differences in behaviours shown by children raised in more difficult environments, and lends physical proof using brain architecture to show why early life events may play such a huge role in later cognitive abilities. Gunnar, M. R. (2010). Neurodevelopmental effects of early deprivation in postinstitutionalized children. Child Development, 81(1), 224-236. Gunnar (2010) used 132 children aged 8-9 to show the differences in neurodevelopment between those raised in institutions and those raised in the natal family. To measure the differences, the children were measured using tasks that have previously been shown to allow researchers to make inferences about neural circuitry. The children raised in institutions showed deficits in tests designed to measure visual memory, attention, visually mediated learning and inhibitory control. However, auditory processing, rule acquisition and planning were seen to be unaffected. The major problem with this study is that it relies on the thought that these tests really do show differences in neurological processes, which may not necessarily be the case. Despite this, the wide range of tests performed and the fact that these tests are definitely measuring some differences between the children does show some support for the belief that early developmental environment can affect later abilities through neurodevelopment. Juffer, F. (2005). Behavioral problems and mental health referrals of internalization adoptees. Journal of the American Medication Association, 293 (20), 2501-2515. This meta-analysis explored the effects of international adoption on children using several different studies to provide support for the thesis that poor medical care and malnutrition as well as psychosocial factors such as separation from parents and neglect and abuse would have a significant effect on behavioural problems and mental health referrals in later life. Using 34 articles about mental health referrals and 64 articles about behavior problems, studies that compared institutionalized and non-institutionalized children were used. Overall, it was found that international adoptees were more likely to have behavior problems than domestic adoptees but these were less often referred to mental health services. The suggestion is that domestic adoptees who are exposed to adversity preadoption are more likely to internalize problems than their international counterparts. However, all adoptees were more likely to have behavioural problems and mental health referrals. The suggestion is here that the psychosocial factors of adoption (maternal separation and neglect or abuse) found in both domestic and international adoptees has more of an effect in later life than the physical (malnutrition and poor medical care) found in international adoptees. Kreppner, J.M. Rutter, M., Beckett, C., Castle, J., Colvert, E., Groothues, C., Hawkins, A., O’Connor, T.G., Stevens, S., & Sonuga-Barke, E.J.S. (2007). Normality and impairment following profound early institutional deprivation: A longitudinal follow-up into early adolscence. Developmental Psychology, 43 (4), 931-946. DOI: 10.1037/0012-1649.43.4.931 This longitudinal analysis by Kreppner et al (2007) followed children who had been exposed to deprivation in Romanian orphanages before the age of 42 months and measured them across 7 domains of functioning. The results were compared with children adopted from Romania from non-institutional settings and non-deprived UK adoptees. Impairment was shown to be highest in children who were deprived for 6 or more months at the beginning of life compared with all other categories. Although this again focuses on the differences between Romanian adoptees and UK adoptees, it does continue to support the point that there is a link between early psychosocial deprivation and later functioning. This is one of the longest studies ever completed on Romanian adopted children and therefore adds more information than some others – the effects are shown to be long-lasting even when using the same children, thus reducing potential testing or sampling bias. Loman, M. M., Wiik, K. L., Frenn, K. A., Pollak, S. D., & Gunnar, M. R. (2009). Postinstitutionalized childrens development: Growth, cognitive, and language outcomes. Journal of Developmental and Behavioral Pediatrics, 30(5), 426-434. Loman et al (2009) studied children who were adopted from different world regions, acknowledging that much of the previous research has focused on children from Eastern Europe (predominantly Romania). Children were studied five to eleven years after adoption on vision, hearing, growth, cognitive and linguistic abilities. Parents were asked to provide the information in multiple areas, including the preadoptive and postadoptive environments of the children. 44% of children who were adopted were shown to have stunted growth and the majority were poor performers on various cognitive measures. Additionally, intervention service used and academic prowess were much lower in internationally adopted children. This suggests that the effects on later life from early psychosocial deprivation are common across individuals adopted from many different countries and this effect is not just limited to children adopted from Romania. This allows greater generalization of results for use by professional care providers. Marcovitch, S., Goldberg, S., Gold, A., Washington, J., Wasson, C., Krekewich, K., & Handley-Derry, M. (1997). Determinants of behavioural problems in Romanian children adopted in Ontario. International Journal of Behavioral Development, 20(1), 17-31. Marcovitch et al (1997) completed one of the earliest studies on Romanian adopted children adopted in the Ontario area. Although only 56 children were used, there was considerable evidence that children who spent more than six months in institutionalized care were less well-adjusted than those who spent less than six months in similar institutions. Additionally, adjustment patterns were examined and secure attachment was less frequent than observed in non-adopted children and there was no avoidant attachment in the sample. This was not related to length spent in institutions as would be expected. Interestingly, the group of 56 children was considered overall to be relatively well-adjusted, which contrasts with some of the later results suggesting that the early damage is long-lasting. One problem with this study is that it also observes Romanian adoptees (who are by far the most commonly observed group in this topic) and therefore the results may not generalize to children adopted from other areas. Morison, S. J., & Ellwood, A.-L. (2000). Resiliency in the aftermath of deprivation: a second look at the development of Romanian orphanage children. Merrill-Palmer Quarterly, 46(4). Morrison & Ellwood (2000) also looked at children adopted from Romanian children but compared them with Canadian-born non-adopted children and children adopted from Romania at an earlier age (before the age of 4 months). The children were assessed using the Stanford-Binet Intelligence Scale – a very well-respected measure of intelligence – and their home lives were assessed using Home Observation for the Measurement of the Environment scale. It was found that Romanian orphanage children scored much lower than Canadian-born never-adopted individuals on the intelligence scale and scored lower on other psychosocial measures. However, this study also shows that there may actually be hope for these children as a higher HOME scale score was shown to be positively associated with improvements after adoption. Unlike the majority of other studies, this one suggests that the effects of early development may not last forever in children exposed to early traumas. The use of the Stanford-Binet Scale should also be acknowledged as it is widely considered to be one of the most reliable measures of intelligence, even for children. Additionally, the results of this study corroborate with those from British studies, suggesting that the differences between Romanian adopted children and Western non-adopted children are consistent throughout many countries. Rutter, M.L., Kreppner, J.M., & O’Connor, T.G. (2001). Specificity and heterogeneity in children’s responses to profound institutional privation. The British Journal of Psychiatry, 179: 97-103. doi: 10.1192/bjp.179.2.97 Rutter et al (2001) aimed to show the different behavioural patterns that are associated with institutional privation. In this study, 165 children were adopted from Romania before the age of 42 months old and all were compared at the ages of four and six years old with 52 children from non-deprived adoptive backgrounds. As with many other studies of Romanian children, seven different domains of functioning were studied. Attachment problems, inattention, hyperactivity, autistic features and cognitive impairment were all found in higher levels in those children who were adopted from Romania. However, in contrast to results found in some other studies, psychosocial functioning including emotional difficulties, relationships with peers and conduct were not affected. This adds to the knowledge base by investigating a wide range of behavioral and cognitive features. The use of 165 children is a large cohort compared with other studies, but the use of specifically Romanian children does mean that it can be quite difficult to generalize results to those adopted from outside this country. Sachser, N., Hennessy, M.B., & Kaiser, S. (2011). Adaptive modulation of behavioural profiles by social stress during early phases of life and adolescence. Neuroscience and Biobehavioral Reviews, 35 (7), 1518-33. doi:10.1016/j.neubiorev.2010.09.002 Sachser et al (2011) examined the development of behavior profiles in later life with relation to social stressors during development. Although this is not a study in itself, it does gather a wide range on information about both human and non-human studies. The conclusion is, from the investigation, that social instability during certain developmental periods can bring about a neuroendocrine masculinization in females and less typical male traits in males. Additionally, anxiety is increased in children (and animal young) when the world during development is socially threatening. It is hypothesized that the relationship to the environment may be mediated by maternal hormones and therefore being apart from the mother during crucial periods of development may mediate later behaviors. Additionally, this study also looks at the effect of experiences had during adolescence as it is hypothesized from the information gathered that experiences during this time can modulate earlier behaviors and psychosocial programming. Much of the other research focuses on young children only, so it is interesting to consider that some information suggests that a later, more harmonious environment may mitigate some of the effects from a stressful childhood. Tottenham, N., Hare, T.A., Quin, B.T., McCarry, T.W., Nurse, M., Gilhooly, T., Millner, A., Galvan, A., Davidson, M.C., Eigsti, I., Thomas, K.M., Freed, P.J., Booma, E.S., Gunnar, M.R., Altemus, M., Aronson, J., & Casey, B.J. (2010). Prolonged institutional rearing is associated with atypically large amygdala volume and difficulties in emotional regulation. Developmental Science, 13 (1), 46-61. doi: 10.1111/j.1467-7687.2009.00852.x Tottenham et al (2010) studied the physical differences between brains of adopted and non-adopted children. By using magnetic resonance imaging (MRI), differences in the volumes of the brain and limbic systems were measured. Additionally, anxiety and internalization behaviors were examined using the Screen for Child Anxiety Related Emotional Disorders and the Child Behavior Checklist – two well-acknowledged sources of information. This is one of the few studies on the topic that actually examines the differences in brain structure between the two groups of people and how this affects their psychosocial functioning. It was found that adoption at a later age was linked to larger corrected amygdala volumes, increased anxiety and poor emotional regulation. Additionally, more than 50% of the children who spent a lot of time in orphanages showed some signs of psychiatric disease, but it was suggested that the differences in amygdala volume were not linked to this increased incidence of anxiety. This further proves that early experiences can have a significant effect on brain structure as well as the consequent impact on behavior, often for the negative. This study is important in the field as it really illustrates why the changes in behavior are observed in adopted children from a neurological perspective. Van der Vegt, E.J.M., Van der Ende, J., Ferdinand, R.F., Verhulst, F.C., & Tiemeier, H. (2009). Early childhood adversities and trajectories of psychiatric problems in adoptees: Evidence for long lasting effects. Journal of Abnormal Child Psychology, 37 (2) 239-249. doi: 10.1007/s10802-008-9272-2. Van der Vegt et al (2009) examined 955 males and 1029 females who were internationally adopted to examine a possible connection between early childhood adversity and later psychiatric problems. Parents were asked to provide information about former abuse and neglect and also how many different families the child was placed with prior to long-term adoption. The Child Behavior Checklist and the Young Adult Behavior Checklist were completed three times when the adoptee was between 10 and 30 years of age. Childhood adversity was frequently associated with higher levels of psychiatric problems, and this was seen in higher levels in individuals who experienced severe maltreatment. This type of psychosocial neglect from parents is therefore linked to later problems. As with many other studies, the effects of the later environment did not often have much of a mediating effect on the chance of developing psychiatric problems. It therefore supports the other evidence that children who were mistreated in earlier life are likely to have persistent problems regardless of the later environment, therefore suggesting a huge role for early development. Van Ijzendoorn, M. H., Luijk, M. P. C. M., & Juffer, F. (2008). IQ of children growing up in childrens homes: A meta-analysis on IQ delays in orphanages. Merrill-Palmer Quarterly, 54(3), 341-366. Intelligence is a controversial topic but IQ scores can be useful in evaluating psychosocial development and later success. Van IJzendoorn et al (2008) completed a meta-analysis of 75 studies on a total of almost four thousand children over 19 countries. The studies used all compared the IQ of children who were living and raised in institutions and those who were raised in foster families. Children who grew up in institutions had generally lower IQs than those who were placed with a foster family, and the younger the child was at placement the higher the IQ score in general. The average IQ of children raised in orphanages has an average of 84 compared with an average IQ of 104 in fostered children. Although the study recognizes that there is work to be done to detect the biological causes of the IQ delays, it does recognize that it is a serious problem that needs to be addressed by staff working in orphanages. The meta-analysis of so many studies across so many different geographical areas means that the results may be easily generalized. Read More