Over the past 17 years, we have conducted the first-ever randomized controlled trial (RCT) of foster care as an alternative to institutional care for young children, the Bucharest Early Intervention Project (BEIP). We now propose an assessment of the participants in this project at age 21 years. The new assessment period will provide novel and important data regarding the transition to adulthood and allow us to answer timely questions about the possibility that adolescence is a second period of marked sensitivity to environmental influences and neural reorganization during which positive caregiving experiences may mitigate, at least in part, the negative effects of early adversity on cognitive, emotional, and neurobiological processes as well as psychopathology. The proposed analyses will make use of the intensive repeated assessments that have occurred beginning when participants were infants and toddles still living in institutions, following them after randomization to care as usual or foster care placement through childhood and adolescence. The longitudinal design is unique in measuring multiple constructs over time spanning early, middle, and late childhood, as well as the pre-pubertal period and the transition to adolescence. This allows us to examine whether domains of development that were unaffected by the early intervention (e.g., Cognitive Control) may improve during adolescence among children in stable caregiving placements, as well as whether additional improvements occur in domains that were positively influenced by the intervention, but where children continued to show difficulties compared to typically developing children (e.g., Reward Responsiveness). These questions will be examined not only using behavioral data, but also in several neurobiological domains that no prior study of early adversity has assessed over such a long period. This includes EEG, ERP, MRI, and DTI data in the neuroimaging domain, as well as comprehensive measures of cognitive, social, and emotional functioning at every time point. Our longitudinal RCT design with repeated assessment of caregiving relationships, psychopathology, and cognitive, emotional, and brain development allows us to examine the joint influence of early and later caregiving experiences in shaping a wide range of developmental processes. We will examine relations between early and later caregiving experiences and risk for psychopathology during adolescence and early adulthood, periods characterized by markedly elevated risk for the onset of psychiatric disorders. Our unique data allow us to evaluate whether specific domains of cognitive, emotional, and neurobiological development ?recover? or ?catch up? for children who experienced severe early deprivation followed by stable caregiving in adolescence. We will also assess the effects of early adversity and positive caregiving experiences on the emergence of developmentally appropriate competencies during young adulthood. Determining the relevance of adolescent caregiving experiences in shaping psychopathology in emerging adulthood is essential to designing interventions that have the potential to buffer the effects of early adversity in the US and worldwide.

Public Health Relevance

In this competing renewal we build on a unique randomized controlled trial of foster care as an alternative for institutional care based in Bucharest, Romania. This valuable sample of children will be studied when participants are 21 years of age when we will examine the long-term consequences of early adversity and early intervention, as well as the effects of positive caregiving during adolescence on brain development, psychopathology, and competent functioning in young adulthood. This unique longitudinal design provides an opportunity to examine whether adolescence is a second window of sensitivity to environmental influences that allows for meaningful brain reorganization for youths in positive environments in ways that may mitigate some of the long-term consequences of early adversity.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Child Psychopathology and Developmental Disabilities Study Section (CPDD)
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Zehr, Julia L
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University of Maryland College Park
Other Health Professions
Schools of Education
College Park
United States
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Guyon-Harris, Katherine L; Humphreys, Kathryn L; Fox, Nathan A et al. (2018) Course of Disinhibited Social Engagement Disorder From Early Childhood to Early Adolescence. J Am Acad Child Adolesc Psychiatry 57:329-335.e2
Troller-Renfree, Sonya; Zeanah, Charles H; Nelson, Charles A et al. (2018) Neural and Cognitive Factors Influencing the Emergence of Psychopathology: Insights From the Bucharest Early Intervention Project. Child Dev Perspect 12:28-33
Sheridan, Margaret A; McLaughlin, Katie A; Winter, Warren et al. (2018) Early deprivation disruption of associative learning is a developmental pathway to depression and social problems. Nat Commun 9:2216
Lamm, Connie; Troller-Renfree, Sonya V; Zeanah, Charles H et al. (2018) Impact of early institutionalization on attention mechanisms underlying the inhibition of a planned action. Neuropsychologia 117:339-346
Tang, Alva; Slopen, Natalie; Nelson, Charles A et al. (2018) Catch-up growth, metabolic, and cardiovascular risk in post-institutionalized Romanian adolescents. Pediatr Res :
Humphreys, Kathryn L; Miron, Devi; McLaughlin, Katie A et al. (2018) Foster care promotes adaptive functioning in early adolescence among children who experienced severe, early deprivation. J Child Psychol Psychiatry 59:811-821
Bick, Johanna; Zeanah, Charles H; Fox, Nathan A et al. (2018) Memory and Executive Functioning in 12-Year-Old Children With a History of Institutional Rearing. Child Dev 89:495-508
Guyon-Harris, Katherine L; Humphreys, Kathryn L; Degnan, Kathryn et al. (2018) A prospective longitudinal study of reactive attachment disorder following early institutional care: considering variable- and person-centered approaches. Attach Hum Dev :1-16
Johnson, Dana E; Tang, Alva; Almas, Alisa N et al. (2018) Caregiving Disruptions Affect Growth and Pubertal Development in Early Adolescence in Institutionalized and Fostered Romanian Children: A Randomized Clinical Trial. J Pediatr 203:345-353.e3
Guyon-Harris, Katherine L; Humphreys, Kathryn L; Fox, Nathan A et al. (2018) Signs of attachment disorders and social functioning among early adolescents with a history of institutional care. Child Abuse Negl 88:96-106

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