The Relation Between Early Psychosocial Deprivation and Mental Health at 12 Years

描述(由申请人提供)：敏感期被定义为大脑在发育过程中以活动模式的形式对经验做出特别反应的一段时间(Daw，1997)。如果经验的存在或不存在导致不可逆转的变化，则这一时间点可被称为“关键”时期(Newport，Hindle，&Jackson，2001；Trachtenberg&Stryker，2001)。在少数领域(即视觉和知觉发展)中，那些允许潜在发展的电路是可塑性的--或使其不可改变--的因素正变得越来越好地被理解。然而，关于婴儿和儿童正常的社会和情绪发展的敏感期的数据很少，关于早期发育期间的异常经历对精神病理学的出现的影响也知之甚少。婴儿从出生起就被遗弃在收容所的案例提供了一个机会，以审查严重的心理社会剥夺和敏感期在典型的神经、社会-情绪和认知发展以及导致精神病态的轨迹中的影响。在过去的10年里，我们进行了这样一项研究，在这项研究中，从出生起就被遗弃并在罗马尼亚布加勒斯特的机构中抚养的婴儿被随机分配到机构中，要么被从机构中带走并被安置到家庭/寄养干预中，要么被留在机构照常照顾。这些儿童已经被跟踪了8岁，到目前为止，54个月的数据表明，a)早期的制度化导致脑电活动的扰动，认知和社会情绪行为的严重缺陷和延迟，以及精神障碍和损害的发生率大大增加，b)我们的干预措施在促进儿童发展方面大体上有效，但c)对于神经活动、语言、认知和社会情绪功能的特定领域，似乎存在调节康复的敏感期。在当前的提案中，我们将扩展这些分析，目的是预测两组儿童的心理健康结果：最初分配到我们的寄养护理干预[FCG]的儿童和最初随机留在机构的儿童(照常照看组[CAUG])，当他们12岁时，我们将比较他们的功能与典型的发育年龄匹配的罗马尼亚儿童(从未收容组[NIG])。使用大脑(EEG/ERP)和行为测量，我们建议1)在12岁时重新检查早期制度化对心理健康结果的长期影响，以及我们使用意向治疗设计在改善精神健康结果负担方面的干预效果；2)检查制度化剂量(在机构中花费的时间百分比)如何影响长期结果；以及3)检查从早期制度化中恢复的敏感期。 与公共卫生相关：目前全世界有7000多万孤儿或被遗弃的儿童。对于照顾这样的孩子，一个常见的社会反应是将他们安置在机构中。有早期住院病史的儿童有发展各种心理健康问题的风险，这些问题的根源是异常的社会行为。目前的申请将审查早期收容对两组有收容历史的儿童的心理健康结果的长期影响，并探索从收容恢复的敏感期。

DESCRIPTION (provided by applicant): Sensitive periods are defined as a time in development during which the brain is particularly responsive to experiences in the form of patterns of activity (Daw, 1997).This time point may be termed a "critical" period if the presence or absence of an experience results in irreversible change (Newport, Hindle, & Jackson, 2001; Trachtenberg & Stryker, 2001). Those factors that allow a circuit underlying development to be plastic - or render it unchangeable - are becoming increasingly well understood in a small number of domains (i.e., visual and perceptual development). However, there is a paucity of data on sensitive periods for normative social and emotional development in human infants and children and little is known about the effects of aberrant experiences during early development on the emergence of psychopathology. The case of infants abandoned since birth into institutions provides an opportunity to examine the effects of severe psychosocial deprivation and sensitive periods in typical neural, social-emotional and cognitive development, as well as in trajectories that lead to psychopathology. Over the past 10 years we have conducted just such a study in which infants, abandoned since birth and raised in institutions in Bucharest, Romania, were randomly assigned either to be removed from the institution and placed into a family/foster care intervention or to be left in the institutions to care as usual. These children have been followed through 8 years of age and thus far, the data through 54 months of age indicate that a) early institutionalization leads to perturbations in brain electrical activity, profound deficits and delays in cognitive and socio- emotional behaviors, and a greatly elevated incidence of psychiatric disorders and impairment, b) our intervention was broadly effective in enhancing children's development, but c) for specific domains of neural activity, language, cognition and social-emotional functioning there appear to be sensitive periods regulating recovery. In the current proposal, we will extend these analyses with the aim to predict mental health outcomes in two groups of children: those originally assigned to our Foster Care intervention [FCG] and those originally randomized to remain in the institution (Care as Usual Group [CAUG] when they are 12 years of age, and we will compare their functioning to typically developing age-matched Romanian children (Never Institutionalized Group [NIG]). Using both brain (EEG/ERP) and behavioral measures, we propose to 1) reexamine, at age 12, the long term impact of early institutionalization on mental health outcomes and the efficacy of our intervention in ameliorating the burden of mental health outcomes using an intent-to-treat design; 2) examine how the dose of institutionalization (percent time spent in an institution) influences long term outcomes; and 3) examine sensitive periods in recovery from early institutionalization. PUBLIC HEALTH RELEVANCE: There are currently more than 70 million orphaned or abandoned children throughout the world. A common societal response to caring for such children is to house them in institutions. Children with histories of early institutionalization are at risk for developing a variety of mental health problems that have their origin in abnormal social behavior. The current application will examine the long term effects of early institutionalization on mental health outcomes in two groups of children with a history of institutionalization, as well as explore sensitive periods in recovery from institutionalization.