Nelson – Bucharest early intervention project

So, I have the distinction of being able to direct a research network that’s concerned with the effects of early experience on brain development. And we actually have a web site which is www.macbrain.org. Now in this group of researchers, there’s about nine or ten of us together who work together which includes developmental neuroscientists, psychologist, psychiatrists, pediatricians and the like. What we’re trying to understand is the role of experience in influencing brain and behavioral development. A common way to do that is to look at the effects of early adverse experiences. So it’s of course ideally the case that we would understand how good experiences affect brain development but one way to infer the role of experience is to see when they’re bad experiences. And common in different parts of the world but particularly in Eastern Europe including Russia and Romania and places like that and in Asia like China there are countless children who are abandoned at birth because their parents, for one reason or another, can’t take care of them. And these children are typically placed in institutions or orphanages. An orphanage is not a good name for these in part because it sounds like the child is an orphan and in fact rarely are they orphaned, they’re simply abandoned. So their parents still are their parents on paper even though they never see the child. So by the late 1980s or early 1990s in Romania there were over 100,000 children in that country who had been essentially abandoned in these institutions and were being brought up by the state.   

And the concern is that these are not optimal living conditions. As a rule for example, with babies, there might be as many as 15-20 babies being taken care of by one person. And of course anyone who’s had children or works with children knows that that’s not optimal. For example, we would never bring our children to a day care centre where there was only one person watching 20 six-month olds. So, inherent in institutional care is a whole range of forms of deprivation. There’s sensory deprivation. Often these children lie in a room staring at a white ceiling and white walls for the first 12 months of life. There’s linguistic deprivation. There’s no one talking to them. There’s cognitive deprivation. There’s no one stimulating them. And very importantly, there’s social and emotional deprivation. There’s no one really loving them.    

So we were interested in looking at the effects of early institutionalization on early brain and behavioral development. But as importantly since we anticipated that this would lead to negative events, that is, behavioral and brain development would not be optimal by being raised in institutional care we were interested in whether we could develop an intervention. So in this project, which is being done with my colleagues Charlie Zina, who’s a child psychiatrist at Tulane University in New Orleans and Nathan Fox who’s a developmental psychologist at the University of Maryland in the United States, we designed a study that worked as follows.  

We looked at a sample of about 150 or so children who were abandoned at birth and placed in various orphanages in Bucharest, Romania and then we had a second sample of children who were being reared at home with their biological families in the greater Bucharest community. After we did a very extensive baseline assessment we measured cognitive development, social/emotional functioning, linguistic development, physical growth and development, brain function, etc. etc.  

After we did the initial baseline assessment, half of the children who had been placed in the institution were then placed in foster care that we created. And these were randomly placed children. So we didn’t pick them we just randomly assigned them. And the reason we could do that, because it raises in your mind some ethical questions about which child goes to foster care and which does not, is that foster care did not really exist in Bucharest at this time. Moreover, this is a country that, for many years, has a history of abandoning children, not taking them in as foster children. So it was very challenging but we eventually identified about 70 or so families willing to take kids in and we could then pay for those placements. 

So the study is longitudinal, meaning that we’re planning to study these children for several years, probably about four years, or there abouts. And what we’re then looking at is the development of the children who are initially placed in the orphanage or the institution and now are placed in foster care relative to the kids who are placed in the institution and stay in the institution and then relative to the comparison group of kids who live at home with their parents.  

So far we’ve been able to look somewhat exhaustively at our baseline data and we’re now just beginning to  look at our foster care data. And the baseline data do show, in fact, very, very negative consequences to this rearing environment. So an example is that for measures of intelligence, broadly defined because it’s hard to measure intelligence in a one-year old, but using a developmental test, if our community sample had scores of about 100 on that test our institutionalized sample was scoring at about 65. On measures of language development and on physical growth and development, the children in the institution are very, very behind in all of those respects. When it comes to social/emotional development one of the things we’re looking at is attachment behavior, and that’s the relationship an infant or a young child has with his or her primary care giver. We’re finding that a great many of these children have disturbances in attachment; whether they’ve failed to develop an attachment or the attachment they’ve developed isn’t as healthy as we’d like to see. So of course now the big question is what are we seeing among those children we’ve placed in foster care? And we’re just beginning to look at those data but we find a dramatic improvement in physical growth and development, a dramatic improvement in language, so their language starts to take off.  

We find that there’s only a very modest change in their cognitive functioning but that may be because the children have only been in foster care a few months. The most intriguing finding is that if we can look at the EEG of the children in the institution versus those in the community sample there are dramatic differences. So, using my hand, if this is the normal EEG, this is the EEG of the children in the institution. It’s a fraction of what we see in the community sample. 

After a minimum of three months in foster care we’re starting to see that EEG normalize and look a little bit more like the kids in the community sample. And as our children get further along in the study we hope to continue to follow them until, on average, they’re about four to five, when they finally finish the study.