Pulse
Fostering Healthy Brains
Minnesota research on brain development in institutionalized orphans has helped change child-welfare policy in Romania as well as children’s lives.
The images are hard to forget: rows of metal cribs lined up like prison cells, each one a “home” for sometimes several infants. Underfed and deprived of attention, many of these children were the legacy of Romania’s communist dictator Nicolae Ceausescu’s child-requirement laws (women were required to have five children before they could receive birth control), abandoned by families who could not afford to care for them.
When Ceausescu was overthrown in 1989, pictures of some of the more than 100,000 orphans in state-run hospitals and institutions made their way around the world. Some of those children found homes in the United States, and some of their adoptive parents ended up in the office of University of Minnesota neonatologist Dana Johnson, M.D., Ph.D., with questions about their child’s growth and development. Johnson runs the International Adoption Clinic at the university and pioneered the idea of adoption medicine in the mid 1980s after adopting his son from India.
“Romania was the first country to open its orphanages to outsiders. We had gone so long in this country—since the late ’50s or early ’60s—since we’d seen children coming out of orphanages, I think the professional community as well as the public had forgotten what it was like to see children who’d lived in institutional care settings,” he says. And for that matter to remember what sort of an indelible mark growing up in such settings left on growth, cognition, and emotional and behavioral development.
Johnson, who primarily deals with children’s physical development, approached a colleague, Charles A. Nelson, Ph.D., then a professor of child psychology, pediatrics, and neuroscience at the university, with questions about the effect such an early experience might have on the brain.
At the time, Nelson was directing a MacArthur Foundation research network on early experience and brain development. His conversations with Johnson led to the Bucharest Early Intervention Project, which began in 2001. The project is the first ever randomized, controlled study designed to look at the effects of social deprivation on children’s brain development.
Reading Faces
With the help of Johnson, who cut through Romania’s bureaucracy, Nelson and researchers from the University of Maryland and Tulane University identified 136 children ages 6 to 30 months living in Bucharest orphanages who did not have obvious medical or developmental problems.
Sixty-seven of the children remained in the institutions, and 69 were placed with foster families—a task that wasn’t as simple as it sounds. “There was no foster care there,” says Nelson. “We had to create it, and we could only identify 69 families we felt were eligible to be good foster parents.” The researchers also selected 72 children who were living with their parents as a control group.
Nelson used electroencephalography (EEG) to measure the children’s brain activity in order to provide an overall metric of brain development; he also used a subset of EEG, the event-related potential (ERP), to examine the children’s neural processing of facial expressions and familiar and novel faces (caregiver versus stranger). Nelson, who left Minnesota for Harvard University last September, and his colleagues presented their findings at a meeting of the American Association for the Advancement of Science last month.
Nelson says that prior to placement in foster care, institutionalized children were found to have much less brain activity than the children in the community sample. Surprisingly, more than two years into foster care, little improvement in the EEG appears evident, although there is a trend toward normalization among those who had resided in foster care the longest.
The most significant changes, however, were in the children’s responses to images showing facial emotion—an indicator of a specific neuropathway in the brain. Researchers measured the amount of time it took for a particular deflection in the EEG to occur in each of the groups (a metric of neural efficiency) as well as the size of the deflection (an index of neuronal efficacy). “Components that occur very early on, like in the first 100 or 200 milliseconds, reflect sensory perceptual processes such as the extraction of the arrangement of facial features, which is the key to understanding facial emotion,” Nelson says. “We found that some of these early components are smaller and later among the kids in institutions versus the community.” Nelson and colleagues also found that the timing and size of the deflections for the kids in the foster care group were starting to resemble those of the kids in the community sample. The researchers reported similar findings when testing the children’s early response to images of a caregiver versus those of a stranger.
Nelson says the next step is to evaluate how these events vary according to the length of time a child has been in foster care.
Making Gains
But will those children who went to live with foster families, or for that matter were adopted, catch up to those who’ve lived with their families since birth? And, if so, to what degree?
That’s the question Nelson and his colleagues are still trying to answer. Johnson, who conducted physical assessments of the children, found that growth (height and weight) improved dramatically in the foster care group over three years. In his work with other international adoptees, he’s found that children often experience dramatic growth in head circumference, an indication of brain growth. “The brain can have some catch-up growth,” he says.
Nelson says that different domains of function, for example IQ versus attachment versus brain activity, will respond differentially to length of time in foster care and age of placement in foster care, and thus, some domains will see more recovery than others. For all domains, researchers expect to find that the less time spent in an institution and the more time spent in foster care, the better the outcomes. “A child who spent two years in an institution versus one who was there six months before being placed in foster care should have very different outcomes,” he says.
So far, the researchers have found that the incidence of depression and anxiety is cut in half for children placed in foster care at 4½ years of age compared with those in institutions. “For those two disorders, foster care has done a great job of reducing the burden of suffering,” Nelson says.
However, they have found no indication that foster care has an effect on attention-deficit hyperactivity disorder. Nelson says he isn’t sure if that’s because the children haven’t spent enough time in foster care for it to make a difference or whether it’s because the neurocircuits that underlie the development of attention are affected by experiences that happen very early in life—long before the children were placed in their foster homes.
Nelson says he hopes to study the children at least through age 7 and to do MRI studies to see if being brought up in an institution leads to structural changes in the hippocampus, amygdala, and portions of the frontal lobe.
Science Changes Lives
In addition to providing insights into the effect of institutionalization on brain development, Nelson and his colleagues believe their findings have led to positive changes in the way Romania treats orphans. For example, Nelson says, the number of Romanian children who are institutionalized has dropped to around 30,000. In addition, the government has instituted state-run foster care programs in Bucharest and is doing what it can to help families keep, rather than abandon, their kids. “This is the fastest I’ve seen science translated to policy because the government has been wowed by our findings,” he says. Nelson also credits pressure from the European Union for such changes.
Perhaps the biggest—and most important—change that’s come out of the study is what Johnson sees when he views videotapes of the children in foster care. “To see how they are when they first come to a foster family versus what they are doing a year or two later, it’s amazing,” he says. “You can throw out all the numbers you want, but all you have to do is watch a few minutes of tape of the kids, and you know what a profound effect foster care has on kids who were institutionalized.”—Kim Kiser