How Institutional Neglect Affects Kids' Brains

Normal Cat Scan image of a child cranium
Normal Cat Scan image of a child cranium

Mon Jan 26, 2015 3:28pm EST

(Reuters Health) – Kids who were raised in a Romanian institution for abandoned children have smaller heads, smaller brains, and different white matter structure than similar kids who were moved into high-quality foster care at an early age.

Even those who were moved into foster care by age two have noticeably different brains from children raised in biological families.

The findings show that the brain's wiring "is profoundly interrupted and perturbed and changed by neglect,” said senior author Charles A. Nelson of Boston Children’s Hospital and Harvard Medical School.

“Some of these changes can be remediated by placement in enriched foster care,” he told Reuters Health by phone.

The Bucharest Early Intervention Project began in 2000 with 136 abandoned babies who had spent more than half of their lives in institutions, which was the standard at the time. At age two, researchers randomly selected half of the babies and arranged for them to be moved into high-quality foster homes.

Ever since then, the researchers have been comparing the kids to similar youngsters in biological families who were never institutionalized.

The institutions had high ratios of babies to caregivers, and children were confined to cribs, with little linguistic or sensory stimulation, to age two. Those babies grew up to have an average IQ of 70.

“On almost every measure we see impairments,” Nelson said.

“We were first concerned that their heads weren’t growing enough,” he said. Then they observed reductions in brain electrical activity and in gray and white matter.

For the current study, the researchers used data from magnetic resonance imaging of 69 of the kids’ brains, taken around age eight.

In analyzing the kids’ white matter “wiring,” they found significant differences in the corpus callosum and in several other areas, including the limbic circuitry and sensory processing areas, according to results in JAMA Pediatrics.

The corpus callosum allows the two halves of the brain to communicate, which is essential for language processing. Other changes may be related to problems with attention and decision-making.

Parents who adopt internationally from countries where this type of institutional orphanage exists may be taking on developmental issues as a result, said Jamie L. Hanson, a postdoctoral Fellow at the Carolina Consortium on Human Development at Duke University who is not part of the Romanian study.

He worked with a population of mostly Russian adoptees now living in Wisconsin, and even after 10 years with their adoptive families, some still face these issues, he said.

“I’ve heard a lot of parents struggle with the constellation of problems that their kids were going through, sometimes a mix of ADHD symptoms, social processing and interacting with peers,” Hanson told Reuters Health by phone.

Nelson said, “Brain development after birth depends on experience, especially during critical periods. If experiences don’t occur during critical periods, developments don’t happen.”

“The brain expects certain experiences when we come into the world, and not just changing diapers, but investing in that kid,” he said.

Most measures, but not all, were improved for kids moved to foster care early in life, he said.

Now at the start of their 16th year of follow-up, all of the kids put in high-quality foster homes have remained there, and all but 14 who were left in the institutions have been moved out by the government, Nelson said.

As the study progressed, Romania banned institutionalization for abandoned infants under age three. Today babies will often be reared in group homes or “social apartments” and moved into the institutions when they reach a legal age, Nelson said.

Comparing adopted and unadopted kids in orphanages is often difficult to do – the kids who were adopted may have been better off than the others in some way. But this study sent kids to foster homes randomly, making the results much more reliable, said Michael E. Behen, a clinical psychologist/neuroscientist in the Translational Imaging Center at Children’s Hospital of Michigan, who is not part of the study.

“We do find similar things for kids who are adopted to an enriched environment in the U.S. or Canada,” Behen told Reuters Health by phone. “We sort of find that over time in that adoptive environment some things seem to normalize.”

In the U.S., children are generally not raised from birth in institutions, but there are foster care situations with varying levels of neglect, and these results will be important for policy makers, Behen said.

SOURCE: JAMA Pediatrics, January 26, 2015.

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