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psychiatric disorder, and prospective data confirm theseassociations.Importantly, childhood adversities are associated withnew disorder onsets in adulthood, even after accountingfor the effects of early-onset disorders, as well as greaterchronicity and severity of lifetime mental disorders. Theeffect of adverse childhood effects on brain developmentis clear. So-called “toxic stress” early in life can lead tofundamental changes in several regions of the brain,including those that subserve learning and memory (e.g.,hippocampus) and those that subserve executivefunctions (e.g., various regions of the prefrontal cortex).DEPRIVATIONMuch of what we know about the effects of experienceon brain development comes from studies with animals,where experiences are altered (e.g., raised in isolation vs.raised in an enriched environment) or absent (e.g., ananimal made blind or deaf to examine the role of visualor auditory input on development). Studying theabsence of experience on human development isobviously more challenging. Here one typically takesadvantage of so-called “accidents of nature,” such as achild who is born with limited or absent vision orhearing. An even more dramatic example of earlydeprivation, however, can be found in studies of childrenraised in bleak institutions.Most institutions for abandoned children arecharacterized by marked psychosocial, linguistic, andsensory deprivation, and their effects on childdevelopment are profound. Elevated psychiatricmorbidity among previously institutionalised children isparticularly striking. One of the most likely explanationsfor the wide range of developmental problems observedamong children exposed to institutional rearing is thatthe deprived environment of an institution does notprovide adequate experience to scaffold normal braindevelopment.Recent studies employing both EEG and MRI-basedimaging tools have led to a number of insights regardingthe link between early deprivation and atypical braindevelopment:1. Across several studies involving both previouslyinstitutionalised and currently institutionalised children,it appears that early severe deprivation leads to adramatic reduction in overall brain volume (both greyand white matter). Importantly, placement into a familycan lead to some (although incomplete) recovery ofwhite matter; unfortunately, the effects on grey matterappear more permanent.2. There is also an effect of institutionalisation on theintegrity of white matter fibres, with dramatic lossesseen in select areas among previously institutionalisedchildren.3. Dramatic reductions in the brain’s electrical activity(EEG) are observed among currently institutionalisedchildren and among previously institutionalised childrenwho were placed in families after 2 years of age;however, among previously institutionalised childrenplaced before age 2, EEG activity begins to resemble thatof never institutionalised children by 8 years of age.Overall, a history of institutionalisation appears to affectboth the anatomy and physiology of brain development.Figure 1 – in these so-called “false colour maps” we illustratethe brain’s electrical activity at rest (resting EEG). To orient thereader, these head plots are viewed from the top, lookingdown. Each small dot represents an EEG sensor. As the colourshifts from blue to red the amount of brain activity isincreasing. The upper left figure illustrates brain activity at 8years of age among children randomly assigned to remain ininstitutional care; the upper right illustrates the brain activityof children who were randomly assigned to foster care afterthe age of 24 months of age. The lower left plot illustrates theEEG of children randomly assigned to foster care before 24months of age and the lower right the EEG of never institutionalisedchildren. There are no differences between thetwo upper plots nor between the two lower plots, indicatingthat the EEG of children placed in foster care before 2 years ofage leads to a profile of brain activity virtually identical to thatof never institutionalised children; conversely, the EEG ofchildren placed after 2 years of age (upper left) is virtuallyidentical to that of children who never left the institution(upper right). 1.What relevance do these patterns of neural functionhave for psychopathology? Here we can draw from theBucharest Early Intervention Project (BEIP). The BEIP is arandomised controlled trial of foster care as anintervention for early institutionalisation. Three groupsof children have been studied through 12 years of age,beginning in infancy. These include children abandonedto institutions and then randomly assigned to remain ininstitutional care or be placed in high-quality foster care,and a group of never institutionalised children who livewith their families. (seehttp://www.bucharestearlyinterventionproject.org/).Two recently published studies from this projectidentified specific patterns of neural function that areassociated with mental health outcomes in childrenexposed to institutionalisation. For example, both thepattern of resting EEG activation (the background brainelectrical activity generated at rest) and the eventrelatedpotential profile during facial processing tasksJanuary 2013 20Serial No 15
(the time-locked brain’s electrical activity generated inresponse to pictures of faces presented on a computermonitor) observed in this sample are associated withsymptoms of attention-deficit/hyperactivity disorder(ADHD).IMPLICATIONSThe Economic and Psychological Upside to EarlyInterventionIn the BEIP we demonstrated that a simple intervention –placing children in families instead of leaving them in aninstitution – benefited many domains of development,particularly if the placement occurred early in the child’slife (generally before the age of 2). The observation thatearly intervention was more efficacious than laterintervention is consistent with other work on earlyintervention. For example, it is well established thatsocial disparities in both educational achievement and inhealth emerge early in development and increasethroughout childhood. A number of economists haveestimated that the economic benefits of interveningearly vs. late are quite high; for example, the HighScopePerry Preschool Study in which children were randomlyassigned to a different preschool environment, wasassociated with differences in both adult income and inadult health behaviour.A second argument in favour of early intervention is thateven short-term change may be cost-saving. Treating apreschooler who is consistently inattentive or disruptivemay not only benefit the child’s educationalperformance, it may also have a positive impact on thechild’s teacher and parents. For example, the teacher candevote more time to teaching and the parents less timemanaging their child’s behaviour and more timeparenting….and working.Finally, the strongest argument in favour of earlyintervention is neural plasticity. Early identification of aproblem behaviour can lead to early intervention, thesuccess of which hinges on the brain’s ability to bemoulded by experience. And, this plastic period maycorrespond to a sensitive period. As a result, notintervening early will represent a missed opportunity.For example, both intervention and prevention programsto reduce substance use/dependence among teens havelow success rates. In contrast, programs or clinicalinterventions implemented during early childhood candecrease the likelihood of adolescent substance use. Itmay be that interventions such as these are effectivebecause they affect neural development during a time ofmaximal plasticity, allowing modifications to the brain’sdevelopmental trajectory.Speaking of the Child Protection System…There are tens of thousands of children in the childprotection system in the United States. If young childrenremain in neglectful or abusive homes for too long, therisk of long-term harm is great. Thus, it is imperative thatwe place the child’s best interests as our highest priority,and we need to be mindful of the science that underlieschild development – that children require consistent,sensitive caregiving from the start, and that past the ageof 2 years, poor caregiving quality (not to mentionoutright abuse or neglect) is increasingly likely todeleteriously affect child development.Implications for <strong>Health</strong>Children experiencing early adversity, includinginstitutional care, do not only suffer psychologically; theirhealth may also suffer. In the BEIP, for example, we havedemonstrated that the physical growth ofinstitutionalised children was compromised, and theyhad shorter telomeres (an index of cellular integrity, andperhaps a predictor of lifespan). We also know thatchildren who grow up with mothers suffering from majordepression show alterations in brain structure duringchildhood. Thus, early adversity not only impactspsychological development, it can also impact biologicaldevelopment and health.ConclusionsThe science is now unambiguous regarding the short-andlong-term hazards of early life adversity - bothpsychological and neural development can becompromised. A healthy society hinges on the healthydevelopment of its children, and a concerted effortshould be made to protect our children wheneverpossible from exposure to early adversity. Here theevidence is clear: reduce the levels of toxic stress inchildren’s lives; for parentless children, raise them infamilies, not institutions; and pay heed to timing – theearlier in life a child is removed from a toxic environmentand placed in a supportive environment, the better.1. Vanderwert RE, Marshall PJ, Nelson CA, Zeanah CH, & Fox NA(2010). Timing of intervention affects brain electrical activity inchildren exposed to severe psychosocial neglect. PLoSOne,5(7), 1-5Further ReadingNational Scientific Council on the Developing Child workingpapershttp://developingchild.harvard.edu/resources/reports_and_working_papers/Nelson, C.A., Furtado, E.A., Fox, N.A., & Zeanah, C.H. (2009).The deprived human brain. American Scientist, 97, 222-229.[http://dana.org/news/features/detail_rop.aspx?id=39774]January 2013 21Serial No 15
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