Effects of Early Psychosocial Deprivation on Mental Health in Adolescence

在过去的12年里，我们进行了有史以来第一次的随机对照试验（RCT），将寄养作为一种干预措施，用于安置在机构中的年轻被遗弃儿童。我们从136名早期被遗弃在机构的罗马尼亚婴儿的样本开始，比较了两组。该样本的一半被随机分配从机构中移除，并被安置到家庭/寄养干预中。另一半则像往常一样留在福利院接受照顾。我们没有干涉布加勒斯特儿童保护当局认为最符合儿童利益的任何安置。随着时间的推移，这两个群体中的一些孩子在罗马尼亚被收养或与他们的亲生父母团聚。在整个过程中，我们都遵循了意向治疗分析，所以最初的小组分配定义了小组成员，尽管事实上很少有“像往常一样照顾”的孩子长期留在机构里。72名从未被收容的儿童的比较样本提供了规范性数据。最初的被收容儿童样本一直被跟踪到12岁。在这12年中，我们在多个评估点评估了儿童的认知、社会、精神和大脑结果。迄今为止，研究结果表明：a)早期收容导致脑电（EEG）和脑结构（MRI）发育紊乱，导致认知和社会情感行为的严重缺陷和延迟，以及精神疾病和损伤的发生率升高；b)我们的干预在促进儿童发育方面广泛有效，但c)对神经活动、语言、那里的认知和社会情感功能似乎是调节恢复的敏感期。在目前的提案中，我们对16岁的儿童进行评估，并扩展这些分析，目的是预测两组儿童的心理健康结果：一组最初被分配到我们的寄养干预组[FCG]，另一组最初被随机分配到机构中（照旧组[CAUG]），我们将把他们的功能与正常发育的年龄相匹配的罗马尼亚儿童（从未被收容组[NIG]）进行比较。我们将使用多种大脑和行为测量方法，1)在16岁时，使用意向治疗设计检查早期机构对心理健康结果的长期影响，以及我们的干预在改善心理健康结果负担方面的效果；2)检查制度化的剂量（在机构中度过的时间百分比）如何影响长期结果；3)检查从早期机构康复的敏感期；4)特别关注冒险行为、药物使用和心理健康结果。

For the past 12 years we have conducted the first-ever randomized controlled trial (RCT) of foster care as an intervention for young abandoned children placed in institutions. Beginning with a sample of 136 Romanian infants abandoned to institutions early in life, we compared two groups. Half of this sample was randomly assigned to be removed from the institution and placed into a family/foster care intervention. The other half remained in the institutions receiving care as usual. We did not interfere with any placements deemed in the children¿s best interest by child protection authorities in Bucharest. Over time, some children from both groups were adopted within Romania or reintegrated with their biological parents. Throughout we followed intent-to-treat analyses so that original group assignment defined group membership despite the fact that few of the ¿care as usual¿ children remained in the institutions over the long run. A comparison sample of 72 never institutionalized children provided normative data. The original sample of institutionalized children has been followed through 12 years of age. We assessed the children's cognitive, social, psychiatric and brain outcomes at multiple assessment points across these 12 years. To date, the results indicate that a) early institutionalization leads to perturbations in the brain¿s electrical (EEG) and structural (MRI) development, with profound deficits and delays in cognitive and socio-emotional behaviors, and an 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 mediating recovery. In the current proposal, we assess the children when they are 16 years of age and 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]) and we will compare their functioning to typically developing age-matched Romanian children (Never Institutionalized Group [NIG]). Using a variety of both brain and behavioral measures, we will 1) examine, at age 16, 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; 3) examine sensitive periods in recovery from early institutionalization; and 4) focus particularly on risk taking behavior, substance use, and mental health outcomes.