Effects of Early Psychosocial Deprivation on Mental Health in Adolescence

在过去的12年里，我们进行了第一次寄养儿童的随机对照试验(RCT)，作为对收容机构中被遗弃的幼儿的干预。我们从136名罗马尼亚婴儿的样本开始，比较了两组婴儿的早期生活状况。这些样本中的一半被随机分配，从机构中带走，并被置于家庭/寄养干预中。另一半人仍在照常接受护理的机构中。我们没有干预布加勒斯特儿童保护当局认为对S儿童最有利的任何安置。随着时间的推移，这两个群体的一些儿童在罗马尼亚境内被收养，或与亲生父母重新团聚。我们始终遵循意向治疗分析，因此最初的小组分配定义了小组成员，尽管从长远来看，几乎没有像往常一样照看的儿童留在机构中。72名从未被收容的儿童的对照样本提供了规范数据。对收容机构儿童的原始样本进行了12岁的跟踪调查。在这12年中，我们在多个评估点评估了儿童的认知、社交、精神和大脑结果。到目前为止，研究结果表明：a)早期制度化导致大脑-S电(EEG)和结构(MRI)发育紊乱，认知和社会情绪行为严重缺陷和延迟，精神障碍和损害的发生率升高；b)我们的干预措施在促进儿童S发育方面大体上有效，但c)对于神经活动、语言、认知和社会-情绪功能等特定领域，似乎存在调解康复的敏感期。在当前的提案中，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：那些最初分配到我们的寄养护理干预[FCG]的儿童和那些最初随机留在机构的儿童(照常照看组[CAUG])，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])。我们将使用各种大脑和行为测量方法，1)在16岁时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减轻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；3)检查从早期制度化中恢复的敏感期；以及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.