Foster care leads to sustained cognitive gains following severe early deprivation.

This study examined longitudinal data from the Bucharest Early Intervention Project, a randomized controlled trial of foster care as an alternative to institutional care following exposure to severe psychosocial deprivation. We report data from 135 participants assessed in early adulthood (age 18 y). We find that 16 y after randomization occurred, those who had been randomized to high-quality foster care had significantly higher IQ scores (9 points, 0.6 SD) than those randomized to care as usual. Mediation analyses provide evidence that the causal effect of the intervention on cognitive ability in early adulthood could be explained, in part, by higher-quality caregiving and attachment security. These findings indicate that early investment in family care as an alternative to institutional care leads to sustained gains in cognitive ability. Fostering caregiving relationships is a likely mechanism of the intervention. In addition, exploratory analyses indicate that stable placements throughout childhood are associated with the greatest long-term gains in cognitive ability. Whether early interventions for infants and young children lead to lasting change has significant implications for decisions to invest in programs aimed at improving children's developmental outcomes.

Impacts of early deprivation on behavioral and neural measures of executive function in early adolescence.

Children reared in institutional settings experience early deprivation that has lasting implications for multiple aspects of neurocognitive functioning, including executive function (EF). Changes in brain development are thought to contribute to these persistent EF challenges, but little research has used fMRI to investigate EF-related brain activity in children with a history of early deprivation. This study examined behavioral and neural data from a response conflict task in 12-14-year-olds who spent varying lengths of time in institutional care prior to adoption (N = 84; age at adoption - mean: 15.85 months, median: 12 months, range: 4-60 months). In initial analyses, earlier- and later-adopted (EA, LA) youth were compared to a group of children raised in their biological families (non-adopted, NA). NA youth performed significantly more accurately than LA youth, with EA youth falling in between. Imaging data suggested that previously institutionalized (PI) youth activated additional frontoparietal regions, including dorsolateral prefrontal cortex, as compared to NA youth. In addition, EA youth uniquely activated medial prefrontal regions, and LA uniquely activated parietal regions during this task. A separate analysis in a larger group of PI youth examined whether behavioral or brain measures of EF varied with the duration of deprivation experienced. Duration of deprivation was negatively associated with activation of default mode network (DMN) regions. Overall, results suggest that there are lasting effects of deprivation on EF, but that those who are removed from institutional care earlier may be able to recruit additional neural resources as a compensatory mechanism.

Receptive and expressive vocabulary performance in 2- to 5-year-olds in care: The role of different care types and temperament.

The detrimental role of institutionalization in children's development has prompted the introduction of alternative care types designed to offer more personalized care. The current study aimed to test whether children in alternative care types (care villages, care homes, and foster care) performed better on vocabulary than those in institutions. The role of temperament, specifically perceptual sensitivity and frustration, and the interaction between temperament and care types on vocabulary performance were also explored. The study involved 285 2- to 5-year-old children from different care types, and they were assessed through receptive and expressive vocabulary tests and temperament scales. The results of the linear mixed model revealed that children in alternative care types exhibited significantly higher vocabulary scores compared with those in institutions. Moreover, perceptual sensitivity showed a positive association with receptive and expressive vocabulary skills and seemed to act as a protective factor by mitigating the lower vocabulary scores in institutions. Frustration moderated vocabulary outcomes differently for children in institutions and foster care, aligning with the diathesis-stress model and vantage sensitivity theory, respectively. The findings emphasize the positive role of alternative care types in vocabulary performance and the importance of children's temperamental traits in this process.

Neural correlates of face familiarity in institutionalised children and links to attachment disordered behaviour.

BACKGROUND: One of the most well-documented sequelae of early maltreatment and institutionalisation is attachment problems, including behaviours under the labels of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). Despite growing evidence of the neurobiological effects of institutionalisation, the neural correlates of these behavioural patterns are largely unknown. METHODS: The current study examined effects of both institutionalisation in general and attachment disordered behaviour, in particular, on brain-based markers of face processing, in 100 Portuguese children (70 currently institutionalised, 30 continuously raised by their families). Children's neural processing of caregiver's and stranger's faces was assessed with Event-Related Potentials (ERPs). RESULTS: Compared to children from the community, institutionalised children showed smaller amplitudes in the N170, to both stranger and caregiver faces. Amongst the institutionalised group, living in a setting with a higher children-to-caregivers' ratio was associated with smaller P400 amplitudes. The display of DSED symptoms was associated with a smaller P1 to both faces, as well as a reduced differentiation between faces in P400 amplitudes and smaller P400 to the stranger's face. In contrast, RAD symptoms were not associated with any ERP measures. CONCLUSIONS: Results replicate previously reported hypoactivation in institutionalised children, in a less-globally deprived setting than past work, indicating that such a pattern is associated with lack of individualised care and increased symptoms of DSED.

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.

Family-based care buffers the stress sensitizing effect of early deprivation on executive functioning difficulties in adolescence.

We examined whether family care following early-life deprivation buffered the association between stressful life events (SLEs) and executive functioning (EF) in adolescence. In early childhood, 136 institutionally reared children were randomly assigned to foster care or care-as-usual; 72 never-institutionalized children served as a comparison group. At age 16 years, adolescents (n = 143; 54% female; 67.1% Romanian) self-reported recent SLEs, completed a battery of memory and EF tasks, and completed a go/nogo task in which mediofrontal theta power (MFTP) was measured using electroencephalogram. More independent SLEs predicted lower EF and more dependent SLEs predicted lower MFTP, but only among adolescents with prolonged early deprivation. Findings provide preliminary evidence that family care following early deprivation may facilitate resilience against stress during adolescence on EF.

Early childhood deprivation is associated with alterations in adult brain structure despite subsequent environmental enrichment.

Early childhood deprivation is associated with higher rates of neurodevelopmental and mental disorders in adulthood. The impact of childhood deprivation on the adult brain and the extent to which structural changes underpin these effects are currently unknown. To investigate these questions, we utilized MRI data collected from young adults who were exposed to severe deprivation in early childhood in the Romanian orphanages of the Ceaușescu era and then, subsequently adopted by UK families; 67 Romanian adoptees (with between 3 and 41 mo of deprivation) were compared with 21 nondeprived UK adoptees. Romanian adoptees had substantially smaller total brain volumes (TBVs) than nondeprived adoptees (8.6% reduction), and TBV was strongly negatively associated with deprivation duration. This effect persisted after covarying for potential environmental and genetic confounds. In whole-brain analyses, deprived adoptees showed lower right inferior frontal surface area and volume but greater right inferior temporal lobe thickness, surface area, and volume than the nondeprived adoptees. Right medial prefrontal volume and surface area were positively associated with deprivation duration. No deprivation-related effects were observed in limbic regions. Global reductions in TBV statistically mediated the observed relationship between institutionalization and both lower intelligence quotient (IQ) and higher levels of attention deficit/hyperactivity disorder symptoms. The deprivation-related increase in right inferior temporal volume seemed to be compensatory, as it was associated with lower levels of attention deficit/hyperactivity disorder symptoms. We provide compelling evidence that time-limited severe deprivation in the first years of life is related to alterations in adult brain structure, despite extended enrichment in adoptive homes in the intervening years.

Intestinal Helminthiasis: Risk factors and relationship with Nutritional status and Anaemia among Institutionalised Children in three States of South-East Nigeria.

BACKGROUND: Intestinal helminthiasis occurs in sub-optimal living conditions with poor hygiene practices and is more prevalent in rural, suburban and institutionalized centres. Heavy helminthic burden negatively affects the nutritional status and the severity of anaemia among children living in orphanages. AIM: To determine the risk factors and relationship of intestinal helminthiasis with nutritional status and anaemia among institutionalized children in three states of South-East Nigeria. METHODS: A cross-sectional study was conducted over seven months involving 198 children recruited from orphanages in Anambra, Ebonyi and Enugu states. Their stool samples were analyzed using the Kato-Katz and Ether concentration techniques, and packed cell volume and anthropometric indices were documented. Data were analyzed. RESULTS: Of the 198 children, 109 (55.1%) were females with a median age of 2.5 years and interquartile range (3 months - 17 years). The prevalence of intestinal helminthiasis was 2.5%. Among the children that had intestinal helminthiasis, 4 (80%) had mono-parasitism with Ascaris lumbricoides, while 1 (20%) had mixed infestation of Ascaris lumbricoides and Trichuris trichiura. There was a significant association (p=0.01) between being infested with intestinal helminthiasis and caregiver handwashing practices. The anthropometric indices demonstrated that 5.6%, 6.6% and 13.1% of the children were underweight, wasted and stunted respectively. No helminth-infested child had malnutrition and only 1 (20%) infested child had moderate anaemia. CONCLUSION: Caregivers' good handwashing practice was associated with reduced prevalence of intestinal infestations and should be encouraged. There was no relationship found between the presence of helminthic infestations and nutritional status or anaemia among the institutionalised children.

CONTEXTE: Les helmintiases intestinales surviennent dans des conditions de vie sous-optimales avec des pratiques d'hygiène médiocres et sont plus fréquentes dans les centres ruraux, périurbains et institutionnalisés. Une charge helminthique importante affecte négativement l'état nutritionnel et la gravité de l'anémie chez les enfants vivant dans des orphelinats. OBJECTIF: Déterminer les facteurs de risque et la relation entre les helmintiases intestinales, l'état nutritionnel et l'anémie chez les enfants institutionnalisés dans trois États du sud-est du Nigéria. MÉTHODES: Une étude transversale a été menée sur sept mois, impliquant 198 enfants recrutés dans des orphelinats des États d'Anambra, d'Ebonyi et d'Enugu. Leurs échantillons de selles ont été analysés à l'aide des techniques de Kato-Katz et de concentration à l'éther, et le volume globulaire et les indices anthropométriques ont été documentés. Les données ont été analysées. RÉSULTATS: Sur les 198 enfants, 109 (55,1 %) étaient des filles avec un âge médian de 2,5 ans et une plage interquartile (3 mois - 17 ans). La prévalence des helmintiases intestinales était de 2,5 %. Parmi les enfants atteints d'helmintiases intestinales, 4 (80 %) présentaient une mono-parasitose à Ascaris lumbricoides, tandis que 1 (20 %) présentait une infestation mixte à Ascaris lumbricoides et Trichuris trichiura. Il y avait une association significative (p=0,01) entre l'infestation par les helmintiases intestinales et les pratiques de lavage des mains par les aidants. Les indices anthropométriques ont montré que 5,6 %, 6,6 % et 13,1 % des enfants étaient respectivement sous-pondérés, émaciés et retardés en taille. Aucun enfant infesté par les helminthes n'était malnutri et seul 1 (20 %) enfant infesté avait une anémie modérée. CONCLUSION: La bonne pratique du lavage des mains par les aidants était associée à une prévalence réduite des infestations intestinales et devrait être encouragée. Aucune relation n'a été trouvée entre la présence d'infestations helminthiques et l'état nutritionnel ou l'anémie chez les enfants institutionnalisés. Mots-clés: Anémie, Enfants, Helminthes, Institutionnalisés, État nutritionnel.

Does rapid rebound height growth come at a neurocognitive cost for previously institutionalized youth?

BACKGROUND: Height growth faltering is associated with less optimal behavioral outcomes and educational achievement. Although catch-up growth after growth delay may result in developmental gains, it may also present as a double-edged sword, with consequences for neurocognitive functioning such as symptoms of inattention and hyperactivity. As previously institutionalized (PI) children experience height delays at adoption and catch-up growth after adoption, they provide a cohort to test associations between catch-up growth and attention deficit hyperactivity disorder (ADHD) symptoms. METHODS: This study used latent growth curve modeling to examine how catch-up in height-for-age growth is related to attention problems in a population of PI youth followed from adoption in infancy through kindergarten. Participants were assessed within three months of arrival into their families (age at entry: 18-36 months). Anthropometrics were measured four times, approximately 7 months apart. Two visits measured behavioral outcomes with parent and teacher reports of ADHD, internalizing, and externalizing symptoms at age 5 and kindergarten. RESULTS: The slope of growth in height z-scores, but not the intercept, was positively associated with parent- and teacher-reported ADHD symptoms in children. A one standard deviation increase in the slope of height z-scores across four assessments was associated with a 0.252 standard deviation increase in ADHD symptoms after controlling for internalizing and externalizing problems, iron status, duration of institutional care, sex, and age. The slope of growth was also associated with internalizing but not externalizing symptoms. CONCLUSIONS: This study demonstrates that PI children exhibit individual trajectories of height growth postadoption. Higher rates of change in height-for-age growth were associated with increased ADHD symptoms. These results suggest that catch-up growth comes 'at the cost' of poor attention regulation and hyperactive behavior.

Associations between Early Psychosocial Deprivation, Cognitive and Psychiatric Morbidity, and Risk-taking Behavior in Adolescence.

OBJECTIVE: Early psychosocial deprivation increases the risk of later cognitive and psychiatric problems, but not all deprived children show these difficulties. Here, we examine the extent to which psychosocial deprivation increases the risk of later cognitive and psychiatric difficulties and the downstream consequences of this for risk-taking behavior in adolescence. METHOD: Children abandoned to institutions early in life were randomly assigned to care-as-usual or a foster care intervention during infancy. A separate group of never-institutionalized children was recruited as a comparison sample. The current follow-up study included 165 children (51% female), 113 with a history of institutionalization and 52 with no such history. At age 12, caregivers reported on children's psychiatric difficulties, and their IQ was assessed by standardized testing. At 16 years, risk-taking behavior was assessed from youth self-reports. RESULTS: Latent profile analysis revealed three subgroups of children with varying levels of cognitive and psychiatric difficulties: Low-Morbidity (n = 104, 62.7%), Medium-Morbidity (n = 46, 27.9%), and High-Morbidity (n = 15, 9.4%). Nearly half of the institutionalized children belonged to the High- or Medium-Morbidity subgroups; and institutionally-reared children were significantly more likely to belong to one of these profiles than never-institutionalized children. Compared to the Low-Morbidity subgroup, membership in the Medium-Morbidity profile was associated with higher levels of risk-taking behavior at age 16 years. CONCLUSIONS: Children who experience psychosocial deprivation are considerably more likely to present with elevated cognitive and psychiatric difficulties in early adolescence and, for some children, this elevation is linked to heightened risk-taking behavior in later adolescence.

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.

Cognitive behavioral program on aggression and self-concept among institutionalized children with conduct disorder.

PURPOSE: To explore the effect of cognitive-behavioral programs on aggression and self-concept among institutionalized children with conduct disorder. A quiz-experimental design was employed in this study. BACKGROUND: Conduct Disorder (CD) is defined as repetitive and persistent behavior that violates the rules of society and social norms. It is also characterized by aggressive behaviors toward people or animals, dishonesty or theft, destruction of property, or serious violation of rules, and persists in children or adolescents in the past 12 months before age 18. METHOD: This research was carried out at the Dammam Observation Center in Saudi Arabia and the Cairo Caring Center in Egypt. Approximately 100 institutionalized children with conduct disorder who had evidence of conduct disorder were included in the study as part of a purposive sampling procedure. The information was gathered through the use of three different tools: Aggressive behavior and self-concept scales, as well as a sociodemographic data sheet. RESULTS: According to the findings, children with conduct disorder exhibited less aggression after participating in cognitive behavioral sessions (p = .011), resulting in lower mean aggression scores for the intervention group than the control group. After the training, about 64% of them had a moderate level of self-concept, whereas 44% of them had a moderate level of self-concept before the program. The study also revealed a statistically significant negative correlation between aggressive behavior and self-concept. CONCLUSION: The post-intervention remediation of aggressive behaviors and self-concept improvement point to the positive effect of the cognitive-behavioral program. The current study recommended that a cognitive-behavioral program is an effective, low-cost, and noninvasive intervention to improve self-concept and minimize aggressive behavior among institutionalized children with conduct disorder.

The prevalence and intensity of intestinal helminths among institutionalized children in three states of South-East Nigeria.

Background: Intestinal helminthiasis is one of the most common and neglected diseases affecting all age groups, especially among school children. It is a disease condition of suboptimal environment and poor personal hygiene, and is more prevalent in children in institutionalized centers. Aims: This study was aimed to determine the prevalence, pattern, and intensity of intestinal helminthiasis among children in motherless babies' homes/orphanages and the relationship between the prevalence and demographic characteristics of the children. The outcome may be useful in strengthening these homes through advocacy to the appropriate authorities on general health promotion and awareness for the management of the homes. Subjects and Methods: It was a descriptive cross-sectional study carried out over 7 months (March-September 2017) in three states of the South-East Nigeria. Prior to the studies ethical clearance and permissions from relevant bodies were obtained. A total of 198 children aged 3 months to 17 years were recruited using multi-stage sampling methods from the homes and orphanages in Anambra, Ebonyi, and Enugu states. Their stool samples were collected and analyzed for ova of intestinal helminths using ether concentration and Kato-Katz techniques.Frequency tables were designed for relevant variables while quantitative variables were summarized using median and interquartile range (IQR). The relationship between demographic factors and presence of intestinal helminths amongst study participants was tested using Chi-square test and Fisher's exact test (FET) where appropriate. All analyses were done at the 5% level of significance, and a P value <.05 was considered statistically significant. Results: : Children aged 1-5 years constituting the highest proportion 110 (55.6%). The median age (IQR) of the participants was 2.5 years (3 months to 17 years). They comprised of 89 (44.9%) males and 109 (55.1%) females with a male: female ratio of 1:1.2. The overall prevalence of intestinal helminths among institutionalized children was 5/198 (2.5%). Ascaris lumbricoides only was seen in four out of five (80%) infested subjects while mixed infestation of A. lumbricoides and Trichuris trichiura was seen in one out of five (20%) subjects. All the infected subjects had light intensity of 100-300 EPG. It was noted that three out of five infested subjects were preschool children. However, the difference between the age groups and intestinal infestation was not statistically significant (P > 0.05). All the subjects with helminthic infection were females. Gender and location of motherless babies' homes/orphanages were not significantly associated with the presence of infestation (P > 0.05). Conclusion: This study showed that the prevalence and intensity of intestinal helminthiasis amongst the surveyed children in the South-Eastern Nigeria are 2.5% and more common among preschool aged children.

Heightened sensitivity to the caregiving environment during adolescence: implications for recovery following early-life adversity.

BACKGROUND: Adolescence has been proposed to be a period of heightened sensitivity to environmental influence. If true, adolescence may present a window of opportunity for recovery for children exposed to early-life adversity. Recent evidence supports adolescent recalibration of stress response systems following early-life adversity. However, it is unknown whether similar recovery occurs in other domains of functioning in adolescence. METHODS: We use data from the Bucharest Early Intervention Project - a randomized controlled trial of foster care for children raised in psychosocially depriving institutions - to examine the associations of the caregiving environment with reward processing, executive functioning, and internalizing and externalizing psychopathology at ages 8, 12, and 16 years, and evaluate whether these associations change across development. RESULTS: Higher quality caregiving in adolescence was associated with greater reward responsivity and lower levels of internalizing and externalizing symptoms, after covarying for the early-life caregiving environment. The associations of caregiving with executive function and internalizing and externalizing symptoms varied by age and were strongest at age 16 relative to ages 8 and 12 years. This heightened sensitivity to caregiving in adolescence was observed in both children with and without exposure to early psychosocial neglect. CONCLUSIONS: Adolescence may be a period of heightened sensitivity to the caregiving environment, at least for some domains of functioning. For children who experience early psychosocial deprivation, this developmental period may be a window of opportunity for recovery of some functions. Albeit correlational, these findings suggest that it may be possible to reverse or remediate some of the lasting effects of early-life adversity with interventions that target caregiving during adolescence.

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 caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation.

Adverse developmental outcomes for some children following institutional care are well established. Removal from institutional care and placement into families can promote recovery. However, little is known about how positive outcomes are sustained across adolescence among children with histories of severe deprivation. The present study examined the caregiving conditions that are associated with attaining and maintaining competent functioning (i.e., outcomes within typical levels) from middle childhood to adolescence following exposure to early institutional care. The participants included children with and without a history of institutional care who had competence assessed at ages 8, 12, and 16 years across seven domains: family relationships, peer relationships, academic performance, physical health, mental health, substance use (ages 12 and 16 years only), and risk-taking behavior. The participants were grouped based on whether they were always versus not always competent and never versus ever competent at ages 8 through 16 years. Adolescents with a history of institutional care were less likely to be consistently competent than those who were family reared. Among those who were exposed to early institutional rearing, maintaining competent functioning from 8 to 16 years was associated with spending less time in institutions and receiving higher-quality caregiving early in life. Ensuring high quality early caregiving may promote competent functioning following early deprivation.

Bone mineral density and fractures in institutionalised children with epilepsy and intellectual disability.

BACKGROUND: Long-term use of antiseizure drugs is associated with a low bone mineral density (BMD) and an increased fracture risk. The literature regarding institutionalised children on chronic antiseizure drugs is limited. Therefore, the aim of this cross-sectional study is to evaluate the prevalence of low BMD and the history of fractures in institutionalised children with epilepsy and intellectual disability (ID). METHODS: A dual-energy X-ray absorptiometry of lumbar spine (L1-L4) and hip was performed in 24 children, residing in a long-stay care facility in the Netherlands. Additionally, serum concentrations of albumin, calcium and 25-hydroxyvitamin D were determined. Data on fractures were retrospectively extracted from the medical files. RESULTS: Ages of the children (14 male and 10 female) ranged from 5 to 17 years with a mean age of 13.0 (±3.2). The criteria of the International Society for Clinical Densitometry (ISCD) were used for classification of bone mineral disorders. Eight (33.3%) children had a normal BMD (Z-score > - 2.0). Of the 16 children with a low BMD (Z-score ≤ - 2.0), three were diagnosed as osteoporotic, based on their fracture history. Ten children (41.7%) were reported to have at least one fracture in their medical history. Serum concentrations of albumin-corrected calcium (2.28-2.50 mmol/L) and (supplemented) vitamin D (16-137 nmol/L) were within the normal range. CONCLUSIONS: This study demonstrated that 67% of institutionalised children with epilepsy and ID had low BMD and 42% had a history of at least one fracture, despite supplementation of calcium and vitamin D in accordance with the Dutch guidelines.

Hyperactive/impulsive symptoms and autistic trait in institutionalized children with maltreatment experience.

The present study examined how maltreatment experience was associated with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) symptoms in children under institutional care. The key caregivers of children and adolescents aged 6 to 18 years who were under institutional care in Nagano prefecture, Japan were asked to answer the background questionnaire, ADHD-Rating Scale, and the Japanese children's version of the Autism-Spectrum Quotient. A total of 378 valid responses were obtained, of which 222 reported maltreatment experience prior to institutionalization. Both hyperactive/impulsive and inattentive scores were significantly higher in the maltreated group. Maltreatment experience was significantly associated with the presence of hyperactive/impulsive symptoms (p = 0.003) and inattentive symptoms (p = 0.027). Particularly, those who had experienced physical abuse were significantly more likely to have hyperactive/impulsive symptoms (p = 0.012) and autistic trait (p = 0.002). Thorough assessment of neurodevelopmental symptoms should be performed when placing children with maltreatment experience into institutional care.

Global deficits in executive functioning are transdiagnostic mediators between severe childhood neglect and psychopathology in adolescence.

BACKGROUND: Children reared in institutions experience profound deprivation that is associated with both heightened levels of psychopathology and deficits in executive functioning (EF). It is unclear whether deficits in EF among institutionally-reared children serve as a vulnerability factor that increases risk for later psychopathology. It is also unclear whether this putative association between EF and psychopathology is transdiagnostic (i.e. cuts across domains of psychopathology), or specific to a given syndrome. Thus, we examined whether global deficits in EF mediate the association between severe childhood neglect and general v. specific psychopathology in adolescence. METHODS: The sample consisted of 188 children from the Bucharest Early Intervention Project, a longitudinal study examining the brain and behavioral development of children reared in Romanian institutions and a comparison group of never-institutionalized children. EF was assessed at age 8, 12, and 16 using a well-validated measure of neuropsychological functioning. Psychopathology was measured as general (P) and specific internalizing (INT) and externalizing (EXT) factors at age 12 and 16. RESULTS: Institutionally-reared children had lower global EF and higher general psychopathology (P) at all ages compared to never-institutionalized children. Longitudinal path analysis revealed that the effect of institutionalization on P at age 16 operated indirectly through poorer EF from ages 8 to 12. No indirect effects involving EF were observed for INT or EXT at age 16. CONCLUSIONS: We conclude that stable, global deficits in EF serve as a cognitive endophenotype that increases transdiagnostic vulnerability to psychopathology in adolescence among those who have experienced profound early neglect.

Pubertal recalibration of cortisol-DHEA coupling in previously-institutionalized children.

As a period of heightened plasticity, puberty may provide a window of opportunity for recalibration of the hypothalamic-pituitary-adrenal (HPA) axis to current conditions. Our group has recently documented evidence for pubertal recalibration of HPA axis reactivity among children internationally adopted as infants from institutions into supportive, well-resourced homes. As a first step at examining potential mechanisms by which puberty may facilitate recalibration of the HPA axis, the current study assessed whether previously-institutionalized (PI) children differed from non-adopted (NA) comparison children in levels of the adrenal steroid hormone dehydroepiandrosterone (DHEA) and in its intra-individual covariation (coupling) with cortisol by adrenal pubertal stage. In an accelerated longitudinal design, 7- to 15-year-olds completed up to 3 annual assessments, which included nurse-conducted pubertal staging and the Modified Trier Social Stress Test for Children (TSST-M). Adrenal (pubic hair) rather than gonadal pubertal stage scores were used in the analysis. Paired salivary cortisol-DHEA samples were available at 60-80 min post-TSST-M. NA and PI children did not differ in DHEA levels, which were higher among children at more advanced pubertal stages (averaged across the sessions) for both groups. For NA children, post-stressor cortisol and DHEA were positively coupled across sessions at all average adrenal pubertal stages. For PI children who were, on average, at earlier adrenal pubertal stages, post-stressor cortisol and DHEA were not coupled, but PI children who were at later pubertal stages demonstrated positive cortisol-DHEA coupling similar to that of the NA children. We suggest that these findings provide insights into processes which may underlie pubertal recalibration of the HPA axis.