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

描述（由申请人提供）：敏感期定义为发育过程中大脑对活动模式形式的经验特别敏感的时间（Daw，1997）。如果经验的存在或不存在导致不可逆的变化，则该时间点可称为"关键"期（纽波特，Hindle，&杰克逊，2001; Trachtenberg &斯特赖克，2001）。这些因素，使电路潜在的发展是塑料-或使其不可改变的-正在越来越多地了解在少数领域（即，视觉和知觉发展）。然而，在人类婴儿和儿童的规范社会和情感发展的敏感时期的数据很少，很少有人知道的影响异常的经验，在早期发展的精神病理学的出现。婴儿出生后被遗弃在收容机构的案例提供了一个机会，可以研究严重的心理社会剥夺和敏感期对典型的神经、社会情感和认知发展以及导致精神病理学的轨迹的影响。在过去10年中，我们进行了这样一项研究，在罗马尼亚布加勒斯特的机构中，出生后被遗弃并长大的婴儿被随机分配到机构中，并被安置到家庭/寄养干预中，或者被留在机构中照常照顾。这些儿童已经被跟踪到8岁，到目前为止，54个月大的数据表明：a）早期机构化导致脑电活动的扰动，认知和社会情感行为的严重缺陷和延迟，以及精神障碍和损伤的发生率大大增加，B）我们的干预在促进儿童的发育方面广泛有效，但c）对于神经活动、语言、认知和社会情感功能的特定领域，似乎存在调节恢复的敏感期。在目前的提案中，我们将扩展这些分析，旨在预测两组儿童的心理健康结果：那些最初分配到我们的寄养干预[FCG]和那些最初随机留在机构[2019 - 02 - 16][2019 - 02][2019 - 02 - 01][2019 - 02][2019 - 01][2019 - 01我们将把他们的功能与年龄匹配的罗马尼亚儿童（从未机构化组[NIG]）进行比较。使用脑（EEG/ERP）和行为测量，我们建议1）在12岁时重新检查早期机构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改善心理健康结果负担的干预效果; 2）检查机构化的剂量如何（在机构中度过的时间百分比）影响长期结果; 3）检查从早期机构化中恢复的敏感时期。 公共卫生相关性：目前全世界有7 000多万孤儿或被遗弃儿童。照顾这些儿童的一个共同的社会反应是将他们安置在机构中。有早期机构化历史的儿童有发展各种心理健康问题的风险，这些问题源于异常的社会行为。目前的应用程序将研究早期机构化对两组有机构化历史的儿童心理健康结果的长期影响，以及探索从机构化中恢复的敏感时期。

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.