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About this paper symposium
| Panel information |
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| Panel 16. Prevention and Interventions |
| Paper #1 | |
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| Adaptive Functioning at Age 18 Following Severe Early Deprivation | |
| Author information | Role |
| Kathryn Humphreys, Ph.D., Vanderbilt University, United States | Presenting author |
| Megan Hare, Tulane University, United States | Non-presenting author |
| Ana Cosmoiu, University of Bucharest, Romania | Non-presenting author |
| Nathan A. Fox, University of Maryland, United States | Non-presenting author |
| Charles A. Nelson, Harvard Medical School, United States | Non-presenting author |
| Charles H. Zeanah, Tulane University School of Medicine, United States | Non-presenting author |
| Abstract | |
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Adaptive functioning, essential for independent living, is particularly affected in individuals exposed to severe early deprivation, such as those raised in institutional care. This study investigates the long-term impact of foster care as an alternative to institutional care on adaptive functioning in young adults, using data from the Bucharest Early Intervention Project (BEIP). The BEIP is a randomized controlled trial designed to examine the effects of high-quality foster care on children exposed to psychosocial deprivation. We assessed 134 participants (55.2% female) in early adulthood (mean age = 18.9 years). Adaptive functioning was measured using the Vineland Adaptive Behavior Scales (Vineland), which evaluates communication, socialization, and daily living skills. Results demonstrated that, 16 years after randomization, individuals assigned to foster care exhibited significantly higher adaptive functioning, particularly in communication and socialization skills, compared to those in the care as usual condition (who typically experienced continued institutional care). There was not a statistically significant intent-to-treat difference for daily living skills. Both groups with a history of institutional care exposure had lower levels of adaptive functioning, across all domains, relative to never institutionalized community comparison participants. Standard scores were translated to age equivalencies, matching one’s level of functioning with the expectations for individuals at given ages. While the never institutionalized group had an average age equivalence of 18.91 years, those in the foster care group were estimated as having levels of functioning equivalent to 15.20 years, and the care as usual age equivalence was 12.45 years. These findings emphasize the likely long-term costs of early deprivation, as well as the benefits of early placement in high-quality foster care for children exposed to severe early deprivation. The study highlights the importance of nurturing, family-based environments in supporting adaptive functioning, which is crucial for success in adulthood. These results have significant implications for policies promoting foster care as a viable alternative to institutional care and underscore the need for early interventions to improve long-term outcomes for vulnerable populations. |
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| Paper #2 | |
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| Effects of Early Institutional Care on Emerging Adults' Error Monitoring Skills | |
| Author information | Role |
| Dr. Emilio Alejandro Valadez, Ph.D., University of Maryland, United States | Presenting author |
| Savannah McNair, University of Maryland, United States | Non-presenting author |
| Alena Quinn, University of South Carolina, United States | Non-presenting author |
| Sonya Troller-Renfree, Teachers College Columbia University, United States | Non-presenting author |
| George Buzzell, Florida International University, United States | Non-presenting author |
| Ranjan Debnath, Justus-Liebig University, Germany | Non-presenting author |
| Anca Radulescu, Tanner Foundation, Romania | Non-presenting author |
| Charles H. Zeanah, Tulane University Medical School, United States | Non-presenting author |
| Charles A. Nelson, Harvard Medical School, United States | Non-presenting author |
| Nathan A. Fox, University of Maryland, United States | Non-presenting author |
| Abstract | |
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Introduction: Error monitoring, a key aspect of cognitive control involving detection of one’s own mistakes, is one mechanism linking early adverse experiences with the later emergence of psychopathology. Findings from the Bucharest Early Intervention Project (BEIP) indicate that previously institutionalized children and adolescents have blunted neural responses to errors (relative to correct trials) than individuals randomized to foster care or than never-institutionalized individuals. Among those randomized to foster care, older age at foster care placement (greater time spent in institutional care) was also associated with blunted neural responses to errors. However, it remains unclear how long institutionalization-related differences in error monitoring persist, and whether they are still present in adulthood. The current study addresses this question using flanker EEG data from the BEIP study’s long-term, 21-year follow-up assessment. Study Population: Participants included 79 young adults enrolled in the BEIP study while they were infants or toddlers in institutional care in Bucharest, Romania. As part of BEIP, this sample had been randomized to either remain in institutional care (care-as-usual-group; CAUG; n = 38) or transition to high-quality foster care (foster care group; FCG; n = 41). An additional comparison group of 36 young adults who had never been institutionalized was recruited during childhood (never-institutionalized group; NIG). Hypothesis: At the 21-year assessment, the CAUG will continue to demonstrate attenuated neural responses to errors on the flanker task compared to both the FCG and NIG groups. Methods: At age 21 years, participants completed an arrow Flanker task. During the task, EEG was recorded using a 64-channel geodesic sensor net. Trials were time-locked to the participant’s button presses. Only incongruent error trials and incongruent correct trials were included in analyses. Analyses focused on the error-related negativity (ERN), a frontocentral event-related potential sensitive to error commission, and its analog measured during correct trials (the correct-related negativity, or CRN). Due to the multidimensional nature of the EEG data, group comparisons were performed with cluster-based permutation tests implemented in the FieldTrip toolbox for MATLAB. Results: For group-averaged waveforms, see Figures 1 and 2. There were no significant group differences in ERN amplitudes (ps > .05). However, the CAUG showed significantly larger (more negative) CRN amplitudes than both the FCG (p = .037) and the NIG (p < .001). A follow-up comparison focusing on the FCG revealed that participants placed in foster care after age 24 months showed significantly larger CRN amplitudes than those placed in foster care before age 24 months (p = .019). Conclusions: Compared to the other two groups, the CAUG demonstrated an exaggerated, error-like neural response on correct trials. Similar effects were observed among FCG participants who entered foster care later in life. In light of the random group assignment, this pattern of results suggests institutional care may cause long-term disruptions in the error monitoring system that persist at least into early adulthood, possibly indicating prolonged vulnerability to psychopathology. Future work will examine potential links between institutionalized individuals’ error monitoring development and mental health trajectories. |
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| Paper #3 | |
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| Early Psychosocial Deprivation Impacts Cortical Brain Structure Development Into Adulthood | |
| Author information | Role |
| Kathryn Garrisi, University of North Carolina Chapel Hill, United States | Presenting author |
| Kate A. McLaughlin, Balmer Institute, United States | Non-presenting author |
| Nathan A. Fox, University of Maryland, United States | Non-presenting author |
| Charles A. Nelson, Harvard Medical School, United States | Non-presenting author |
| Margaret A. Sheridan, University of North Carolina, Chapel Hill, United States | Non-presenting author |
| Abstract | |
| A variety of early experiences are necessary for typical brain development. Children raised in environments that deprive them of these species-expectant experiences, including environments lacking a sensitive and responsive caregiver, have impaired sensory, motor, linguistic, and social development as well as executive functioning and neural correlates (McLaughlin et al., 2017; Sheridan et al., 2017). In animal models, multifaceted deprivation in the early caregiving environment including maternal separation and unstimulating environments results in decreased dendritic arborization and brain volume, and impacts neural structure and behavior into adulthood (Bennett et al., 1996; Bennett et al., 1974; Diamond et al., 1972). No study to date has been able to test the causal impact of caregiver deprivation in childhood on neural structure in adulthood in humans. The current study utilized the Bucharest Early Intervention Project, the only randomized controlled trial of institutionalization, to investigate how early psychosocial deprivation impacts cortical structure development into adulthood. Whole-brain analyses revealed that at age 21, participants that had been raised in families from birth had thinner superior frontal and inferior temporal cortex, and larger surface area in the precentral and postcentral cortex compared to those who had been exposed to institutionalization. At 21 years of age, participants who were randomized into foster care before 24 months of age had thicker precentral and rostral middle frontal cortex compared to those randomized after 24 months. In our longitudinal analyses we found increased thinning in the right middle temporal cortex and decreased surface area in the left cuneus and lingual cortex between 16-21 years of age for those raised in families from birth compared to those exposed to institutionalization. We found increased thinning of the right rostral middle frontal cortex and decreased surface area in the right rostral middle frontal cortex between 16-21 years of age in those randomized to foster care before 24 months compared to after. Finally, we conducted longitudinal region-of-interest analyses of the superior temporal sulcus, anterior cingulate cortex, and inferior frontal gyrus at age 8, 16, and 21 years. We found that while there was a decrease in cortical thickness in these regions from ages 8 to 16 years in all three groups (care as usual, foster care, and never-institutionalized), there was not a significant change in cortical thickness from 16-21 years of age, in line with recent findings in another institutionalization study (Mackes et al., 2020). Our whole-brain results largely replicate our findings at age 16 (Sheridan et al., 2022). In sum, these findings indicate that early psychosocial deprivation altered cortical brain development by adolescence, and the effects broadly persisted into adulthood, as further supported by the longitudinal region-of-interest analyses. This is true even if the exposure to institutionalization was brief, as in children randomized to foster care after 24 months of age. Overall, this study illuminates the causal impacts of exposure to deprivation on structural neurodevelopment, and the lasting repercussions of early-life deprivation. | |
| Paper #4 | |
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| Associations Between Early Institutional Rearing and Foster Care Intervention with Executive Function During Early Adulthood | |
| Author information | Role |
| Dr. Mark Wade, Ph.D., University of Toronto, Canada | Presenting author |
| Cora Mukerji, Bryn Mawr College, United States | Non-presenting author |
| Nathan A. Fox, University of Maryland, United States | Non-presenting author |
| Charles H. Zeanah, Tulane University Medical School, United States | Non-presenting author |
| Charles A. Nelson, Harvard Medical School, United States | Non-presenting author |
| Abstract | |
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INTRODUCTION: Children and youth raised in institutional care often experience pronounced psychosocial deprivation that is associated with alterations in biobehavioral function. One domain that is particularly impacted by early deprivation is executive function, with multiple studies of institutionally-reared individuals showing difficulties across a number of domains that persist through adolescence, even after individuals are removed from those environments and placed into family care. However, the long-term effect of institutional care on executive function into adulthood, and the capacity of family-based care to reverse these effects, is unknown. This study drew on data from the Bucharest Early Intervention Project (BEIP)—the only randomized controlled trial of family-based foster care for individuals exposed to early institutional care—to test the long-term effect of early deprivation on executive function, and the potential recovery-promoting effects of early family-based foster care. HYPOTHESES: On the basis of prior evidence of persistent and/or increasing disparities in executive function between never- and ever-institutionalized youth on a number of domains of executive function (Wade et al., 2019), as well as minimal evidence that foster care intervention ameliorates these difficulties, we expected to observe continued difficulties with executive function through early adulthood between groups that were not recovered by the intervention. STUDY POPULATION: Participants included 135 young adults (mean age = 23.3 year; 57.8% female) participating in the BEIP. Of these, 91 had experienced early deprivation as a result of having been reared in Romanian institutions, with 46 of these having left those institutions in early childhood for family-based foster (foster care group), and the remaining 45 experiencing prolonged institutional care (care-as-usual group). A further 44 participants who had never been exposed to early deprivation were recruited as a comparison group (never-institutionalized group). METHODs: Participants completed multiple subtests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). Data across the following tasks were collected: Delayed Match to Sample (DMS; attention and short-term visual memory), Paired Associates Learning (PAL; visual-spatial memory and new learning), One-Touch Stockings of Cambridge (OTS; spatial planning and problem-solving), Spatial Working Memory (SWM; updating of spatial information in memory), and Stop Signal Task (SST; response inhibition). Independent samples t-tests were used to evaluate two sets of comparisons for each domain: (1) differences between never- and ever-institutionalized individuals as a test of the long-term effect of having ever been exposed to early deprivation; (2) differences between foster care and care-as-usual youth as a test of the recovery-promoting effect of early family care. RESULTS: Across all domains except the OTS, ever-institutionalized young adults performed significantly worse than never institutionalized young adults (all t > 2.00, ps < .05). There were no significant differences between young adults who left the institutions as children for foster care and those who experienced prolonged institutional rearing (all t < 1.00, ps > .40). Findings suggest that psychosocial deprivation in the context of institutional care early in life has persistent effects on executive function into young adulthood, and that removal from deprived environments and placement into family care does not mitigate these difficulties. |
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Effects of Early Adversity Last Into Young Adulthood: Findings from the Bucharest Early Intervention Project
Submission Type
Paper Symposium
Description
| Session Title | Effects of Early Adversity Last Into Young Adulthood: Findings from the Bucharest Early Intervention Project |