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Social Neglect During Institutional Care May Alter Children's Brain Development

black and white photo of Romanian orphans from 1990s sitting in bed
Children in a Romanian orphanage in Bucharest in February 1990. | Mike Abrahams/ Alamy Stock Photo

Social neglect of children in institutions may profoundly affect a developmental stage that takes place in the brain during mid-childhood to adolescence, suggests new research in Science Advances. The evidence, from the Bucharest Early Intervention Project, also shows that children placed in foster care are comparatively less affected, supporting the value of this intervention as an alternate to institutionalization.

"The brain is our organ of behavior, emotions, and cognition. If we want healthy adolescents, they need healthy brains," said Margaret Sheridan, first and corresponding author of the study and director of the Child Imaging Research on Cognition and Life Experiences Lab (CIRCLE Lab) at the University of North Carolina at Chapel Hill.

Using MRI scans of children's brains at nine years old and then at 16 years old, Sheridan and her colleagues found that prefrontal cortex thinning — a process  associated with behavioral stepping stones, including emotional regulation — can be stunted by whether, and when, a child is placed in a foster care environment.

"The impact of early environments on brain development has been demonstrated experimentally in rodents, however, until now we lacked experimental evidence that this same process happened in humans," said Sheridan.

Neglect and Neurodevelopment

Concerns about the damage of childhood institutionalization surfaced in the American conscience nearly five years ago, when the Trump administration's "zero tolerance" policy for immigrants crossing the United States-Mexico border first came to light.

"Separating children at the border and placing them into institutional care is an example of a policy which is very likely to impair future brain development for those children and thus impair their future mental health and cognitive capacity," said Sheridan.

But before Trump-era immigration policies underscored the harms of early social deprivation, the world witnessed the psychosocial consequences of extreme adversity on children in Romanian orphanages. Due to the dictator Nicolae Ceaușescu's decrees against birth control and abortion in the late 1960s, these institutions were over capacity. Many became sites where systemic cruelty and neglect ran unchecked.

By turn of the 21st century, it became clear that children who survived these settings suffered from social dysfunction and cognitive impairment. To understand why this was and potentially help the children recover, scientists with the Bucharest Early Intervention Project (BEIP) began studying the beneficial impact of foster care in 2000.

In the years that have passed, researchers have continued to study the ways in which institutionalization can hurt children. Now, Sheridan and her team offer new insights as to how neglect can physically alter neurodevelopment.

"We wanted to demonstrate that early adversity doesn't just change how you think or feel later but that changes in your environment, which start even before you can remember, shape the development of your brain years later," said Sheridan.

Finding Physical Proof

During early to mid-adolescence, the brain matures by undergoing many changes, such as prefrontal cortex thinning. Sheridan and her team had good reason to believe those changes could be impacted by early neglect.

"Researchers suspect that early adversity has this impact because childhood is characterized by enhanced [neural] plasticity. As the brain develops, it grows to be the most efficient for the environment it will encounter in the future, so early environments appear to preferentially shape brain development," said Sheridan.

By monitoring the brains of child BEIP participants at ages nine and 16, the group was able to look for differences in total grey matter volume, cortical surface area and thickness, and white matter. They observed that those who remained in institutional care throughout this timeframe had far less thinning than their counterparts in foster care. The findings also indicated there was a correlation between decreased thinning and occurrence of mental disorders related to emotional self-regulation.

"It's very difficult to quantify the size of this effect due to the methodological approach but I think the association between brain differences and behavioral outcomes we care about, such as IQ and mental health, really speak to the importance of these results," said Sheridan.

Within the foster care subset studied, infants placed at 24 to 36 months of age had less thinning in adolescence than those placed before they were 24 months old. Such results overlap with other work in the BEIP sample that implied children who entered in foster care earlier had higher IQs and more typical neural functions.

"Foster care intervention as an alternative to institutional care in our study demonstrates efficacy in terms of protecting children's health and brain development," said Sheridan, noting this foster care was child-centric and attachment-based. Families received thorough support from a team of social workers.

Looking forward, the team hopes that their research could be used to inform policies that strengthen local, state, and federal infrastructures for foster care networks in the United States.

"Working to support foster families with similar programs and decreasing the amount of time children in the foster care system are in institutional settings is critical to supporting healthy brain development for America's youth," said Sheridan.


Abigail Eisenstadt

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