In this exploratory study, we are proposing to apply cognitive and behavioral assessments and advanced imaging techniques to identify the functional and structural neural alterations that are associated with history of adversity and subsequent exposure to different care settings in Chinese children who have been orphaned by AIDS. These children are a subsample of a longitudinal cohort (n=800) in an ongoing NIH-funded psychosocial intervention trial (R01NR013466). The sample will include 90 orphaned children from three care settings (orphanages, kinship care, community based group homes) in Henan China. The children, across settings (n= 30 from each setting), will be matched on age, gender, duration of care, age of entry into care, ethnicity, parent and child education. Specifically, we are proposing to use cognitive and behavioral assessments and advanced imaging techniques such as functional (resting state functional MRI sequences) and structural (diffusion weighted imaging sequences) MRI protocols to investigate whether care settings are differentially related to healthy or pathological functional and structural neural abnormalities (Aim 1). We hypothesize that children raised in kinship and orphanage settings will show increased incidence of specific cognitive/behavioral impairments and altered patterns of functional and structural connectivity, including reduced node strength and efficiency from lateral and medial temporal seeds to subcortical/cortical targets; and increased indices of connectivity strength in local frontal and cerebellar connectivity as compared to community placed children. We also are attempting to more fully characterize some of the neurodevelopmental phenotypes associated with loss and subsequent care, and to determine whether functional and structural neural outcomes depend on the interaction of duration in care x care setting (Aim 2). Here we hypothesize that specific cognitive and behavioral symptoms will be differentially associated with distinct functional and structural abnormalities, and further tha the magnitude of neurodevelopmental outcomes will depend on the interaction of duration in care x care setting - children in low quality care (orphanages, kinship settings) will show greater incidence of cognitive/behavioral symptoms and increased magnitude of neural abnormalities (identified in Aim 1) as time in care setting is increased. Conversely, children in high quality cae (community group homes) will show less incidence of cognitive/behavioral patterns and reduced magnitude of neural abnormalities over time. We further expect that the relationships identified between neurodevelopmental outcomes and duration in care x care setting will be moderated by age of loss/entry into care. Finally, we are testing whether children orphaned during their first 3 years will show greater improvement over time in high quality settings (community group homes) and increased magnitude of problems/abnormalities as compared to children orphaned >8 years of age; whereas, we expect that children orphaned >8 years will show similar levels of healthy outcomes in high quality care, and reduced magnitude of negative outcomes over time in low quality care.
Given the number of children orphaned worldwide and the devastating effects of parental HIV/AIDS on children, it is of critical importance to discern the types of care setting which are associated with optimal neurodevelopmental outcomes, and further to identify timing and care setting parameters that are associated with health/pathology. It also is important to understand the full cognitive/behavioral and associated neurological substrates that are commonly identified in children with histories of early adversity and subsequent placement into different care settings. If the project is successfully completed, this proposal will ultimately 1) identify which type of care arrangement is associated with optimal neurodevelopmental outcomes and 2) identify time and care setting parameters for healthy/pathological outcomes in children experiencing early loss/care, which be useful for making policy decisions on how to best care for such orphaned children, as well as tailor psychological promotion intervention for these children within and across different care settings; and 3) identify links between different behavioral phenotypes and distinct neural alterations which may suggest more targeted differential treatment protocols for children evidencing specific problematic adjustment to such historical adversity.
