ADVERSE OUTCOMES IN CHILDREN WITHOUT FAMILIES: Long- and Short-Term Effects of Institutional Care in the Bucharest Early Intervention Project

Transcription

1 ADVERSE OUTCOMES IN CHILDREN WITHOUT FAMILIES: Long- and Short-Term Effects of Institutional Care in the Bucharest Early Intervention Project

2 The global situation Research of post-institutionalized children from multiple world regions: 44% with stunted growth Performed poorly on cognitive and language screens More likely to fall behind academically More likely to use intervention services A meta-analysis of 75 studies (more than 3,800 children in 19 countries): (Loman et al) on average an IQ 20 points lower than their peers in foster care. (van Ijzendoom et al)

3 Bucharest Early Intervention Project Longitudinal study: began in 2000 Seeks to examine the effects of early institutionalization on brain and behavior development. Followed children from infancy through to now Assessed a wide range of developmental domains including measure of physical growth, cognitive function, social-emotional development, attachment, brain development, and more. Tulane University, University of Maryland, Boston Children s Hospital

4 Sequelae of Institutional Care Growth

5 Growth Failure Growth failure in early life, either in terms of height or weight gain, can reflect inadequate development and subsequent dysfunction of a wide range of organs and tissues. Indeed attainment of a certain physical stature is not a goal, in and of itself, but rather it is a proxy for the success of basic developmental processes. Discover New Ways to Achieve Healthy Growth Bill & Melinda Gates Foundation Global Health Discovery and Nutrition

6 Z-Score Growth Failure in Institutionalized Children Height Weight Rutter Mason Johnson L. Miller BEIP

7 Baseline Growth BEIP Low Birth Weight Normal Birth Weight Controls Height Weight OFC Wt/Ht p <.05

8 Profound Growth Failure In Institutionalized Romanian Children n= (f) 3-19 y

9 Pubertal Development in Institutionalized Children Median Age of Onset (n=327) Breast Development Testicular Enlargment Romanian Orphans US Controls Pubic Hair Female Pubic Hair Male

10 11 y girl 14 y girl 17 y girl

11 Sequelae of Institutional Care Development

12 Brain Development 15.5 Weeks 22 Weeks 23 Weeks ~25 Weeks 27 weeks Full Term Adult Brain

13 Human Growth Brain Growth

14 BEIP-Bailey MDI at Baseline 110 Bailey MDI Institution Family p <.05

15 Family Institution 3-5 Hz 6-9 Hz Hz

16 EEG : Absolute Beta Power BEIP-8 Years μv Institution Family p <.05 Maturational lag in nervous system dependent

17 Total Cortical Volume (cc) BEIP-Total Brain Volume at 8 Years Institutio Family Grey Matter White Matter p <.05

18 BEIP-Mental Health at 54 Months 60. Institution Family Any Axis 1 Disorder p <.05 Any Emotional Disorder Any Behavioral Disorder

19 Stereotypies Defined as repetitive, invariant movements with no obvious goal or function. Commonly associated with a number of different medical conditions, including autism and mental retardation. Are known to develop in association with atypical and especially restricted sensory environments or deprivation.

20 Motor Skills at 8 years Bruininks-Oseretsky Test of Motor Proficiency Institution Family Institution p <.05 Family

21 Speech Delay- Receptive Expression Emergent Language Scales (0-3 years) Expressive Receptive 20 0 Institution Family Institution Family Baseline 30 Months p <.05

22 Speech Delay- Reynell Developmental Language Scales ( years) Expressive Receptive 23 0 Institution Family Institution Family p < Months 42 Months

23 Telomere Length and Institutional Care Bucharest Early Intervention Project Telomere length at 8 years of age was inversely related to the length of institutionalization. Girls-length of institutionalization at baseline (22 months of age Boy-length of institutionalization at 54 months of age

24 Summary- Lack of parental care during early life is associated with profound alterations in: Growth Brain development Brain size Electrical activity Brain structure Cognition Attachment Mental health Behavior Competence Negative Behavior Emotional Expression Stereotypies Motor skills Language Chromosome structure

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