Effects of early intervention and the moderating effects of brain activity on institutionalized children's social skills at age 8

The impact of out-of-home care on brain development: a brief review of the neuroscientific evidence informing our understanding of children's attachment outcomes

Researchers interested in the effects of early experiences of caregiving adversity have employed neuroscientific methods to illuminate whether and how such environmental input impacts on brain development, and whether and how such impacts underpin poor socioemotional outcomes in this population. Evidence is compelling in documenting negative effects on the individual's neurodevelopment following exposure to adverse or disadvantaged environments such as institutionalization or maltreatment. Neuroimaging research focused specifically on attachment-relevant processing of socioemotional stimuli and attachment outcomes among children looked-after is scarcer, but largely consistent. This review begins by summarizing the key general brain structural and functional alterations associated with caregiving deprivation. Then, neuroscientific evidence that is more directly relevant for understanding these children's attachment outcomes, both by employing social stimuli and by correlating children's neural markers with their attachment profiles, is reviewed. Brief interpretations of findings are suggested, and key limitations and gaps in the literature identified.

Effects of foster care intervention and caregiving quality on the bidirectional development of executive functions and social skills following institutional rearing

Institutional rearing negatively impacts the development of children's social skills and executive functions (EF). However, little is known about whether childhood social skills mediate the effects of the foster care intervention (FCG) and foster caregiving quality following early institutional rearing on EF and social skills in adolescence. We examined (a) whether children's social skills at 8 years mediate the impact of the FCG on the development of EF at ages 12 and 16 years, and (b) whether social skills and EF at ages 8 and 12 mediate the relation between caregiving quality in foster care at 42 months and subsequent social skills and EF at age 16. Participants included abandoned children from Romanian institutions, who were randomly assigned to a FCG (n = 68) or care as usual (n = 68), and a never-institutionalized group (n = 135). At ages 8, 12, and 16, social skills were assessed via caregiver and teacher reports and EF were assessed via the Cambridge Neuropsychological Test Automated Battery. Caregiving quality of foster caregivers was observed at 42 months. FCG predicted better social skills at 8 years, which in turn predicted better EF in adolescence. Higher caregiver quality in foster care at 42 months predicted better social skills at 8 and 12 years, and better EF at 12 years, which in turn predicted 16-year EF and social skills. These findings suggest that interventions targeting caregiving quality within foster care home environments may have long-lasting positive effects on children's social skills and EF.

Early deprivation alters structural brain development from middle childhood to adolescence

Hypotheses concerning the biologic embedding of early adversity via developmental neuroplasticity mechanisms have been proposed on the basis of experimental studies in animals. However, no studies have demonstrated a causal link between early adversity and neural development in humans. Here, we present evidence from a randomized controlled trial linking psychosocial deprivation in early childhood to changes in cortical development from childhood to adolescence using longitudinal data from the Bucharest Early Intervention Project. Changes in cortical structure due to randomization to foster care were most pronounced in the lateral and medial prefrontal cortex and in white matter tracts connecting the prefrontal and parietal cortex. Demonstrating the causal impact of exposure to deprivation on the development of neural structure highlights the importance of early placement into family-based care to mitigate lasting neurodevelopmental consequences associated with early-life deprivation.

Timing of adoption is associated with electrophysiological brain activity and externalizing problems among children adopted internationally

This study investigated middle childhood resting electroencephalography (EEG) and behavioral adjustment in 35 internationally adopted children removed from early caregiving adversity between 6 and 29 months of age. Older age of adoption was associated with more immature or atypical profiles of middle childhood cortical function, based on higher relative theta power (4-6 Hz), lower relative alpha power (7-12 Hz), lower peak alpha frequency, and lower absolute beta (13-20 Hz) and gamma (21-50 Hz) power. More immature or atypical EEG spectral power indirectly linked older age of adoption with increased risk for externalizing problems in middle childhood. The findings add to existing evidence linking duration of early adverse exposures with lasting effects on brain function and behavioral regulation even years after living in a stable adoptive family setting. Findings underscore the need to minimize and prevent children's exposures to early caregiving adversity, especially in the first years of life. They call for innovative interventions to support neurotypical development in internationally adopted children at elevated risk.

Growth in self-regulation over the course of adolescence mediates the effects of foster care on psychopathology in post-institutionalized children: a randomized clinical trial

Children reared in institutions experience severe psychosocial deprivation, with lasting consequences for social and emotional development. This study evaluated growth trajectories of self-regulation from ages 8 to 16 among institutionally-reared children randomized to foster care (foster care group; FCG) or to remain in institutional care (care as usual group; CAUG), compared to a never-institutionalized group (NIG). We then tested a developmental pathway by which growth in self-regulation reduces general psychopathology at 16 for FCG versus CAUG. FCG experienced modest growth in self-regulation over adolescence and "caught up" to NIG by age 16. The beneficial effect of foster care on psychopathology operated through growth in self-regulation; part of this effect was further mediated by reduced peer difficulties for FCG. Findings reveal that the effects of foster care on self-regulation emerge over adolescence and that growth in self-regulation is a mechanism by which foster care mitigates the impact of institutionalization on psychopathology.

Long-Term Effects of Institutional Care and Enhanced Attachment Relationships on Close Adolescent Friendships

This study examined whether early institutional rearing and attachment security influence the quality and quantity of friendships at age 16 in 138 participants, including children abandoned to institutions in Bucharest, Romania, who were randomized to care as usual (n = 45, 26 female), or foster care (n = 47, 25 female), and a never-institutionalized group (n = 46, 18 female). Adolescents in the foster care group with secure attachment to their foster mothers at 42 months were comparable to never-institutionalized adolescents in having more friends and more positive behaviors with their friend during dyadic interactions, compared to the foster care group with insecure attachment and care as usual group. Interventions targeting early child-caregiver attachment relationships may help foster the ability to build positive friendships in adolescence.

Early institutionalized care disrupts the development of emotion processing in prosody

Millions of children worldwide are raised in institutionalized settings. Unfortunately, institutionalized rearing is often characterized by psychosocial deprivation, leading to difficulties in numerous social, emotional, physical, and cognitive skills. One such skill is the ability to recognize emotional facial expressions. Children with a history of institutional rearing tend to be worse at recognizing emotions in facial expressions than their peers, and this deficit likely affects social interactions. However, emotional information is also conveyed vocally, and neither prosodic information processing nor the cross-modal integration of facial and prosodic emotional expressions have been investigated in these children to date. We recorded electroencephalograms (EEG) while 47 children under institutionalized care (IC) (n = 24) or biological family care (BFC) (n = 23) viewed angry, happy, or neutral facial expressions while listening to pseudowords with angry, happy, or neutral prosody. The results indicate that 20- to 40-month-olds living in IC have event-related potentials (ERPs) over midfrontal brain regions that are less sensitive to incongruent facial and prosodic emotions relative to children under BFC, and that their brain responses to prosody are less lateralized. Children under IC also showed midfrontal ERP differences in processing of angry prosody, indicating that institutionalized rearing may specifically affect the processing of anger.

Improving social-emotional competence in internationally adopted children with the Attachment and Biobehavioral Catch-up intervention

Children adopted internationally experience adverse conditions prior to adoption, placing them at risk for problematic social-emotional development. The Attachment and Biobehavioral Catch-up (ABC) intervention was designed to help internationally adoptive parents behave in ways that promote young children's social-emotional competence. Participants included 131 parent-child dyads randomly assigned to receive either ABC (n = 65) or a control intervention (n = 66). In addition, 48 low-risk biologically related parent-child dyads were included as a comparison group. At follow-up assessments conducted when children were 24 to 36 months old, internationally adopted children who received the ABC intervention had higher levels of parent-reported social-emotional competence than children who received a control intervention. In addition, observational assessments conducted when children were 48 and 60 months of age showed that internationally adopted children who received ABC demonstrated higher social-emotional competence than children who received a control intervention. Adopted children who received the control intervention, but not the ABC intervention, displayed more difficulties with social-emotional competence than low-risk children. Finally, postintervention parent sensitivity mediated the effect of ABC on observed child social-emotional competence in parent interactions, controlling for preintervention parent sensitivity. These results demonstrate the efficacy of a parenting-focused intervention in enhancing social-emotional competence among children adopted internationally.

Friendship and social functioning following early institutional rearing: The role of ADHD symptoms

Early institutional rearing is associated with increased risk for subsequent peer relationship difficulties, but the underlying mechanisms have not been identified. Friendship characteristics, social behaviors with peers, normed assessments of social problems, and social cue use were assessed in 142 children (mean age = 10.06, SD = 2.02; range 7-13 years), of whom 67 were previously institutionalized (PI), and 75 were raised by their biological families. Anxiety and attention-deficit/hyperactivity disorder (ADHD) symptoms, often elevated among PI children, were examined as potential mediators of PI status and baseline social functioning and longitudinal follow-ups (2 and 4 years later). Twenty-seven percent of PI children fell above the Child Behavior Checklist Social Problems cutoff. An examination of specific social behaviors with peers indicated that PI and comparison children did not differ in empathic concern or peer social approach, though parents were more likely to endorse aggression/overarousal as a reason that PI children might struggle with friendships. Comparison children outperformed PI children in computerized testing of social cue use learning. Finally, across these measures, social difficulties exhibited in the PI group were mediated by ADHD symptoms with predicted social problems assessed 4 years later. These findings show that, when PI children struggle with friendships, mechanisms involving attention and behavior regulation are likely contributors.

How Early Experience Shapes Human Development: The Case of Psychosocial Deprivation

Experience plays an essential role in building brain architecture after birth. The question we address in this paper is what happens to brain and behavior when a young child is deprived of key experiences during critical periods of brain development. We focus in particular on the consequences of institutional rearing, with implication for the tens of millions of children around the world who from an early age experience profound psychosocial deprivation. Evidence is clear that deprivation can lead to a host of both short- and long-term consequences, including perturbations in brain structure and function, changes at cellular and molecular levels, and a plethora of psychological and behavioral impairments.

Signs of attachment disorders and social functioning among early adolescents with a history of institutional care

BACKGROUND

Institutional rearing is associated with increased risk for reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). Disorders of attachment involve disturbances in children's primary caregiving relationships, and are likely to disturb multiple domains of social functioning.

OBJECTIVE

To examine associations between signs of RAD and DSED and social functioning in early adolescence.

PARTICIPANTS AND SETTING

Our participants were 110 children with a history of institutional rearing and 50 community comparison adolescents from the Bucharest Early Intervention Project, based in Bucharest, Romania. Participants were assessed at age 12 years (M age in years = 12.80, SD = 0.71).

METHOD

Signs of RAD and DSED were obtained through caregiver report. Reports of social functioning were provided by caregivers and teachers. General and specific domains of social functioning were identified using bi-factor modeling. A general social functioning factor and four specific factors were revealed: peer conflict, caregiver views as victim, teacher views as victim, and social competence.

RESULTS

Signs of RAD predicted poorer general social functioning (β=-0.36, p < .01, 95% confidence interval [CI] [-.33, -.09]) and poorer social competence (β=-0.38, p < .01, 95% CI[-0.05, -.01]) above and beyond time spent in institutional care and placement disruptions. Signs of DSED (β=-0.38, p < .001, 95% CI[-0.49, -.16]) along with placement disruptions (β=-0.22, p < .05, 95% CI[-.29, -.01]) predicted poorer general social functioning above and beyond time spent in institutional care. Signs of DSED predicted higher scores on caregiver views as victim (β = 0.29, p < .05, 95% CI[0.02, 0.14]) and lower scores on social competence (β=-0.29, p < .01, 95% CI[-.06, -.01]) above and beyond time spent in institutional care and placement disruptions.

CONCLUSIONS

Attachment disorder signs in early adolescence are problematic for social functioning, although the manifestation of these social difficulties differs based on whether RAD or DSED signs are present.

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

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.

Targeted Estimation of the Relationship Between Childhood Adversity and Fluid Intelligence in a US Population Sample of Adolescents

Many studies have shown inverse associations between childhood adversity and intelligence, although most are based on small clinical samples and fail to account for the effects of multiple co-occurring adversities. Using data from the 2001-2004 National Comorbidity Survey Adolescent Supplement, a cross-sectional US population study of adolescents aged 13-18 years (n = 10,073), we examined the associations between 11 childhood adversities and intelligence, using targeted maximum likelihood estimation. Targeted maximum likelihood estimation incorporates machine learning to identify the relationships between exposures and outcomes without overfitting, including interactions and nonlinearity. The nonverbal score from the Kaufman Brief Intelligence Test was used as a standardized measure of fluid reasoning. Childhood adversities were grouped into deprivation and threat types based on recent conceptual models. Adjusted marginal mean differences compared the mean intelligence score if all adolescents experienced each adversity to the mean in the absence of the adversity. The largest associations were observed for deprivation-type experiences, including poverty and low parental education, which were related to reduced intelligence. Although lower in magnitude, threat events related to intelligence included physical abuse and witnessing domestic violence. Violence prevention and poverty-reduction measures would likely improve childhood cognitive outcomes.

Early deprivation disruption of associative learning is a developmental pathway to depression and social problems

Exposure to psychosocial deprivation is associated with elevations in numerous forms of impairment throughout the life-course. Disruptions in associative learning may be a key mechanism through which adversity, particularly psychosocial deprivation, increases risk for impairment. Existing data consistent with this claim come entirely from correlational studies. Here, we present the first experimental evidence relating psychosocial deprivation and disruptions in multiple forms of associative learning. Using data from the Bucharest Early Intervention Project, we demonstrate that randomized placement into a family caregiving environment during the infant/toddler period as compared to prolonged institutional care normalizes two forms of associative learning in early adolescence: reward responsivity and implicit motor learning. These forms of associative learning significantly mediate the effect of institutional rearing on depressive symptoms and peer relationships. In sum, we provide evidence for a novel pathway linking early experience to psychopathology and peer relationships through basic associative learning mechanisms.

Early childhood deprivation such as institutionalization can greatly affect early development. Here, the authors study children who were raised in institutions but later randomly placed in foster care vs. not, to understand how early-life deprivation affects associative learning in adolescence.

Alternatives for abandoned children: insights from the Bucharest Early Intervention Project

The Bucharest Early Intervention Project is the first and only randomized controlled trial of foster care as an alternative to institutional care for orphaned and abandoned children. Across various domains of brain and behavioral development we demonstrated that children in families developed more favorably than children in institutions, that foster care remediates some but not all compromises associated with institutional placement and that earlier placement in foster care leads to more developmental gains in some but not all domains. In addition to early placement, higher quality of care provided and more stable placements for children all enhanced outcomes. These results have important implications for science, practice and policy.

Oxytocin and Social Relationships: From Attachment to Bond Disruption

Social relationships throughout life are vital for well-being and physical and mental health. A significant amount of research in animal models as well as in humans suggests that oxytocin (OT) plays an important role in the development of the capacity to form social bonds, the mediation of the positive aspects of early-life nurturing on adult bonding capacity, and the maintenance of social bonding. Here, we focus on the extensive research on a socially monogamous rodent model organism, the prairie vole (Microtus ochrogaster). OT facilitates mating-induced pair bonds in adults through interaction with the mesolimbic dopamine system. Variation in striatal OT receptor density predicts resilience and susceptibility to neonatal social neglect in female prairie voles. Finally, in adults, loss of a partner results in multiple disruptions in OT signaling, including decreased OT release in the striatum, which is caused by an activation of the brain corticotropin releasing factor (CRF) system. The dramatic behavioral consequence of partner loss is increased depressive-like behavior reminiscent of bereavement. Importantly, infusions of OT into the striatum of adults prevents the onset of depressive-like behavior following partner loss, and evoking endogenous OT release using melanocortin agonists during neonatal social isolation rescues impairments in social bonding in adulthood. This work has important translational implications relevant to the disruptions of social bonds in childhood and in adults.

The Effects of Psychosocial Deprivation on Attachment: Lessons from the Bucharest Early Intervention Project

The absence of typical caregiving, including warm and responsive parenting, has been suggested to significantly affect the young child's ability to form adaptive relationships with adults and peers. The Bucharest Early Intervention Project (BEIP), a randomized controlled trial of foster/family care for young children with a history of institutionalization has provided the context to assess these relationships. Here we review data from the BEIP with specific focus on attachment. The findings clearly show the importance of early family care on the emergence of attachment, on the prevention of psychopathology, and on links between brain and social behavior.

Future Directions in Childhood Adversity and Youth Psychopathology

Despite long-standing interest in the influence of adverse early experiences on mental health, systematic scientific inquiry into childhood adversity and developmental outcomes has emerged only recently. Existing research has amply demonstrated that exposure to childhood adversity is associated with elevated risk for multiple forms of youth psychopathology. In contrast, knowledge of developmental mechanisms linking childhood adversity to the onset of psychopathology-and whether those mechanisms are general or specific to particular kinds of adversity-remains cursory. Greater understanding of these pathways and identification of protective factors that buffer children from developmental disruptions following exposure to adversity is essential to guide the development of interventions to prevent the onset of psychopathology following adverse childhood experiences. This article provides recommendations for future research in this area. In particular, use of a consistent definition of childhood adversity, integration of studies of typical development with those focused on childhood adversity, and identification of distinct dimensions of environmental experience that differentially influence development are required to uncover mechanisms that explain how childhood adversity is associated with numerous psychopathology outcomes (i.e., multifinality) and identify moderators that shape divergent trajectories following adverse childhood experiences. A transdiagnostic model that highlights disruptions in emotional processing and poor executive functioning as key mechanisms linking childhood adversity with multiple forms of psychopathology is presented as a starting point in this endeavour. Distinguishing between general and specific mechanisms linking childhood adversity with psychopathology is needed to generate empirically informed interventions to prevent the long-term consequences of adverse early environments on children's development.

Effect of socioeconomic status disparity on child language and neural outcome: how early is early?

It is not news that poverty adversely affects child outcome. The literature is replete with reports of deleterious effects on developmental outcome, cognitive function, and school performance in children and youth. Causative factors include poor nutrition, exposure to toxins, inadequate parenting, lack of cognitive stimulation, unstable social support, genetics, and toxic environments. Less is known regarding how early in life adverse effects may be detected. This review proposes to elucidate "how early is early" through discussion of seminal articles related to the effect of socioeconomic status on language outcome and a discussion of the emerging literature on effects of socioeconomic status disparity on brain structure in very young children. Given the young ages at which such outcomes are detected, the critical need for early targeted interventions for our youngest is underscored. Further, the fiscal reasonableness of initiating quality interventions supports these initiatives. As early life adversity produces lasting and deleterious effects on developmental outcome and brain structure, increased focus on programs and policies directed to reducing the impact of socioeconomic disparities is essential.

[Attachment and Adoption: Diagnostics, Psychopathology, and Therapy]

This presentation describes the development of attachment between adopted children and their adoptive parents with a focus on the particular issues seen in international adoptions. The questions of settling in, trauma in the country of origin, and the motivations of the adoptive parents will be discussed. Diagnosis and various psychopathological manifestations will be examined, as will outpatient and inpatient modes of therapy. The treatment of children of various ages will be covered along with the necessity for intensive counseling and psychotherapy for the adoptive parents. This will enable the parents to work through early trauma, which will give them and their adopted child the basis for developing healthy attachment patterns. This in turn will enable the child to mature and integrate into society. Possibilities of prevention are discussed. Many of the approaches discussed here regarding attachment and adoption may be applied to foster children and their foster parents.

Language development of internationally adopted children: Adverse early experiences outweigh the age of acquisition effect

We compared English language and cognitive skills between internationally adopted children (IA; mean age at adoption=2.24, SD=1.8) and their non-adopted peers from the US reared in biological families (BF) at two time points. We also examined the relationships between outcome measures and age at initial institutionalization, length of institutionalization, and age at adoption. On measures of general language, early literacy, and non-verbal IQ, the IA group performed significantly below their age-peers reared in biological families at both time points, but the group differences disappeared on receptive vocabulary and kindergarten concept knowledge at the second time point. Furthermore, the majority of children reached normative age expectations between 1 and 2 years post-adoption on all standardized measures. Although the age at adoption, age of institutionalization, length of institutionalization, and time in the adoptive family all demonstrated significant correlations with one or more outcome measures, the negative relationship between length of institutionalization and child outcomes remained most robust after controlling for the other variables. Results point to much flexibility and resilience in children's capacity for language acquisition as well as the potential primacy of length of institutionalization in explaining individual variation in IA children's outcomes.

LEARNING OUTCOMES

(1) Readers will be able to understand the importance of pre-adoption environment on language and early literacy development in internationally adopted children. (2) Readers will be able to compare the strength of the association between the length of institutionalization and language outcomes with the strength of the association between the latter and the age at adoption. (3) Readers will be able to understand that internationally adopted children are able to reach age expectations on expressive and receptive language measures despite adverse early experiences and a replacement of their first language with an adoptive language.

Social communication difficulties and autism in previously institutionalized children

OBJECTIVE

To determine the risk of difficulties with social communication and restricted/repetitive behaviors as well as the rate of autism in children institutionalized in early infancy and to assess the impact of a foster care intervention on ameliorating this risk.

METHOD

Children abandoned at birth and raised in institutions in Bucharest, Romania were randomly assigned to a care-as-usual group (institutional care, CAUG), or placed in family-centered foster care (FCG) as part of the Bucharest Early Intervention Project (BEIP). At approximately 10 years of age, the Social Communication Questionnaire (SCQ) was administered to caregivers of children in both groups as well as to parents of a typically developing community sample (Never-Institutionalized group [NIG]) residing in Bucharest, Romania. Children scoring ≥12 on the SCQ underwent clinical evaluation for autism spectrum disorder (ASD).

RESULTS

Caregivers of children with a history of institutionalization reported that these children had significantly more deviant behavior than never-institutionalized children on all subdomains of the SCQ (all p < 0.001). Children in the FCG had significantly lower scores on the SCQ than children in the CAUG (p < .001), particularly in the reciprocal social interaction domain, indicating that the intervention reduced problems in social communication. Three of 60 CAUG children, 2 of 57 FCG children, and none of the NIG children received a formal ASD diagnosis.

CONCLUSION

Early institutional rearing was associated with an increased risk of social communication difficulties and ASD. A family-centered foster care intervention improved social communication skills.

Long term mental health outcomes of Finnish children evacuated to Swedish families during the second world war and their non-evacuated siblings: cohort study

OBJECTIVES

To compare the risks of admission to hospital for any type of psychiatric disorder and for four specific psychiatric disorders among adults who as children were evacuated to Swedish foster families during the second world war and their non-evacuated siblings, and to evaluate whether these risks differ between the sexes.

DESIGN

Cohort study.

SETTING

National child evacuation scheme in Finland during the second world war.

PARTICIPANTS

Children born in Finland between 1933 and 1944 who were later included in a 10% sample of the 1950 Finnish census ascertained in 1997 (n = 45,463; women: n = 22,021; men: n = 23,442). Evacuees in the sample were identified from war time government records.

MAIN OUTCOME MEASURE

Adults admitted to hospital for psychiatric disorders recorded between 1971 and 2011 in the Finnish hospital discharge register.

METHODS

We used Cox proportional hazards models to estimate the association between evacuation to temporary foster care in Sweden during the second world war and admission to hospital for a psychiatric disorder between ages 38 and 78 years. Fixed effects methods were employed to control for all unobserved social and genetic characteristics shared among siblings.

RESULTS

Among men and women combined, the risk of admission to hospital for a psychiatric disorder did not differ between Finnish adults evacuated to Swedish foster families and their non-evacuated siblings (hazard ratio 0.89, 95% confidence interval 0.64 to 1.26). Evidence suggested a lower risk of admission for any mental disorder (0.67, 0.44 to 1.03) among evacuated men, whereas for women there was no association between evacuation and the overall risk of admission for a psychiatric disorder (1.21, 0.80 to 1.83). When admissions for individual psychiatric disorders were analyzed, evacuated girls were significantly more likely than their non-evacuated sisters to be admitted to hospital for a mood disorder as an adult (2.19, 1.10 to 4.33).

CONCLUSIONS

The Finnish evacuation policy was not associated with an increased overall risk of admission to hospital for a psychiatric disorder in adulthood among former evacuees. In fact, evacuation was associated with a marginally reduced risk of admission for any psychiatric disorder among men. Among women who had been evacuated, however, the risk of being admitted to hospital for a mood disorder was increased.

The Effects of Early Institutionalization and Foster Care Intervention on Children's Social Behaviors at Age 8

The present study compared the social behaviors of 8-year-old previously institutionalized Romanian children from the Bucharest Early Intervention Project (BEIP) in two groups: 1) children randomized to foster care homes (FCG), and 2) children randomized to care as usual (remaining in institutions) (CAUG). Children were observed interacting with an age and gender-matched unfamiliar, non-institutionalized peer from the community (NIG) during six interactive tasks, and their behavior was coded for speech reticence, social engagement, task orientation, social withdrawal, and conversational competence. Group comparisons revealed that FCG children were rated as significantly less reticent during a speech task than CAUG children. For CAUG children, longer time spent in institutional care was related to greater speech reticence and lower social engagement. Using an Actor-Partner Interdependence Model, CAUG children's behaviors, but not FCG, were found to influence the behavior of unfamiliar peers. These findings are the first to characterize institutionalized children's observed social behaviors towards new peers during middle childhood and highlight the positive effects of foster care intervention in the social domain.

Effects of early institutionalization on the development of emotion processing: a case for relative sparing?

We tested the capacity to perceive visual expressions of emotion, and to use those expressions as guides to social decisions, in three groups of 8- to 10-year-old Romanian children: children abandoned to institutions then randomly assigned to remain in 'care as usual' (institutional care); children abandoned to institutions then randomly assigned to a foster care intervention; and community children who had never been institutionalized. Experiment 1 examined children's recognition of happy, sad, fearful, and angry facial expressions that varied in intensity. Children assigned to institutional care had higher thresholds for identifying happy expressions than foster care or community children, but did not differ in their thresholds for identifying the other facial expressions. Moreover, the error rates of the three groups of children were the same for all of the facial expressions. Experiment 2 examined children's ability to use facial expressions of emotion to guide social decisions about whom to befriend and whom to help. Children assigned to institutional care were less accurate than foster care or community children at deciding whom to befriend; however, the groups did not differ in their ability to decide whom to help. Overall, although there were group differences in some abilities, all three groups of children performed well across tasks. The results are discussed in the context of theoretical accounts of the development of emotion processing.

Neurological and biological foundations of children's social and emotional development: an integrated literature review

This article provides an integrated review of the expert literature on developmental processes that combine social, biological, and neurological pathways, and the mechanisms through which these pathways may influence school success and health. It begins with a historical overview of the current understanding of how attachment relationships and social environments influence brain development and plasticity and are, therefore, central to the physical and mental health of individuals and populations. It then expands on the effect of plasticity in relation to behavior and learning at school. This article concludes with a discussion of the role the school nurse may play in supporting health and learning by recognizing signs of relational stress and by advocating for prevention strategies.

Rethinking evidence-based practice and two-generation programs to create the future of early childhood policy

Half a century of research and program evaluation has fueled a diverse landscape of early childhood policies and practices that produce a range of positive effects on the life prospects of children who face the burdens of significant adversity. Drawing on advances in neurobiology, developmental psychology, developmental psychopathology, and prevention science, this paper presents a framework for elucidating underlying causal mechanisms that explain differences in outcomes, formulating enhanced theories of change about how to shift developmental trajectories, designing creative interventions and rethinking the concept of a two-generation strategy to produce breakthrough impacts, and launching a new era of investment in young children and their families that will achieve greater reductions in intergenerational disparities in learning, behavior, and health than those produced by current best practices. Particular attention is focused on the hypothesis that substantially better outcomes for vulnerable, young children could be achieved by greater attention to strengthening the resources and capabilities of the adults who care for them rather than by continuing to focus primarily on the provision of child-focused enrichment, parenting education, and informal support. Central to achieving this goal is the need to establish an innovation-friendly environment that embraces fast-cycle sharing, supports risk taking, and celebrates learning from failure.

Adoption: biological and social processes linked to adaptation

Children join adoptive families through domestic adoption from the public child welfare system, infant adoption through private agencies, and international adoption. Each pathway presents distinctive developmental opportunities and challenges. Adopted children are at higher risk than the general population for problems with adaptation, especially externalizing, internalizing, and attention problems. This review moves beyond the field's emphasis on adoptee-nonadoptee differences to highlight biological and social processes that affect adaptation of adoptees across time. The experience of stress, whether prenatal, postnatal/preadoption, or during the adoption transition, can have significant impacts on the developing neuroendocrine system. These effects can contribute to problems with physical growth, brain development, and sleep, activating cascading effects on social, emotional, and cognitive development. Family processes involving contact between adoptive and birth family members, co-parenting in gay and lesbian adoptive families, and racial socialization in transracially adoptive families affect social development of adopted children into adulthood.

Annual Research Review: The neurobiology and physiology of resilience and adaptation across the life course

BACKGROUND

Adaptation is key to survival. An organism must adapt to environmental challenges in order to be able to thrive in the environment in which they find themselves. Resilience can be thought of as a measure of the ability of an organism to adapt, and to withstand challenges to its stability. In higher animals, the brain is a key player in this process of adaptation and resilience, and through a process known as "allostasis" can obtain "stability through change"; protecting homeostasis in the face of stressors in the environment. Mediators of allostasis, such as glucocorticoids, can cause changes in the structure and function of neural circuits, clearly impacting behavior. How developmental stage interacts with stress and leads to long-lasting changes is a key question addressed in this review.

SCOPE AND METHODS

We discuss the concept of allostasis, its role in resilience, the neural and physiological systems mediating these responses, the modulatory role of development, and the consequences for adult functioning. We present this in the context of mediators the brain and body engage to protect against threats to homeostasis. The review has been informed by comprehensive searches on PubMed and Scopus through November 2012.

FINDINGS

Stressors in the environment can have long lasting effects on development, depending upon the stage of life at which they are experienced. As such, adverse childhood experiences can alter resilience of individuals, making it more difficult for them to respond normally to adverse situations in adulthood, but the brain maintains the capacity to re-enter a more plastic state where such effects can be mitigated.

CONCLUSIONS

The brain regulates responses that allow for adaptation to challenges in the environment. The capacity of the brain and body to withstand challenges to stability can be considered as "resilience". While adverse childhood experiences can have long-term negative consequences, under the right circumstances, the brain can re-enter plastic states, and negative outcomes may be mitigated, even later in life.

A translational neuroscience perspective on the importance of reducing placement instability among foster children

Placement instability is a common occurrence among foster children and others involved with child welfare system services, and is associated with negative psychiatric and mental health outcomes. The purpose of this paper is to review and synthesize research in this area and to consider this information in terms of child welfare practice and policy. Evidence from 59 sources is reviewed, including research on (a) the connection between placement instability and poor outcomes; (b) sources of information that can be employed to reliably predict risk for placement instability; and (c) interventions designed to mitigate the effects of placement instability. The available empirical evidence suggests that placement instability and other family chaos is associated with disrupted development of the brain’s prefrontal cortex, which is involved in executive functioning. Poor executive functioning is implicated in elevated risk for ADHD, disruptive behavior disorders, substance abuse, and other forms of disinhibitory psychopathology. This might help to explain the high rates of psychiatric medication prescriptions for foster children. Notably, however, recent research findings have shown that placement instability is both predictable and preventable and that interventions to address placement instability have the potential to mitigate neurobiological and psychiatric effects of prior adversity.