TABLE 2 - uploaded by Karyn N. Audet
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Percentage of Romanian orphan children with height and weight below the third, fifth, 10th and 15th percentiles* in each phase
Source publication
In the present longitudinal study, the physical growth and health of 36 early-deprived postinstitutionalized Romanian orphans (ROs; 17 boys) adopted by Canadian families are documented. Data were collected for each child at three time points: at 11 months postadoption, at 4.5 years of age and at 10.5 years of age. Data from the RO children were com...
Context in source publication
Context 1
... height and weight data are presented in *1 = elementary school, 2 = some high school, 3 = high school completion, 4 = vocational or some college or university, 5 = college or university graduate, 6 = grad- uate or professional school; † Age at time target child was assessed; ‡ Gross annual income: 1 = less than $20,000, 2 = $21,000 to $30,000, 3 = $31,000 to $40,000, 4 = $41,000 to $50,000, 5 = $51,000 to $60,000, 6 = $61,000 to $70,000, 7 = $71,000 to $80,000, 8 = $81,000 to $90,000, 9 = $91,000 to $100,000, 10 = above $100,000. a, b, c, Indicate means that differ significantly (P<0.05) from one another Table 2. The mean birth weight percentile for the 20 RO children whose parents had birth weight information was 22nd. ...
Citations
... As experienced in institutional care, early caregiving deprivation has been associated with a higher risk of growth stunting in children at the time of adoption into families in the United States, Great Britain, and Western Europe (Miller & Hendrie, 2000;Reid et al., 2017;Rutter, 1998;Van IJzendoorn et al., 2007). However, once removed from deprivation and placed in families, children adopted from orphanage-like institutions exhibit rapid catchup growth and are typically within normal anthropometric parameters for age within a year of adoption or fostering (Le Mare & Audet, 2006;Miller et al., 2010;Palacios et al., 2014;Pomerleau et al., 2005;Van IJzendoorn et al., 2007). ...
In cross‐sectional analyses, early institutional care is associated with shorter stature but not obesity during puberty in children adopted into US families. We examined whether shorter stature and leaner body composition in youth adopted internationally from institutions would continue as puberty progressed. We also examined whether current psychosocial stress would moderate the association between early institutional deprivation and growth during adolescence. Using an accelerated longitudinal design and linear mixed‐effects models, we examined the height and body mass index (BMI) of 132 previously institutionalized (PI) and 176 nonadopted (NA) youth. We examined youth aged 7–15 at the beginning of the study three times across 2 years. Nurses assessed anthropometrics and pubertal status. Current psychosocial stress was measured using the Youth Life Stress Interview. Our results indicated that PI youth remained shorter and leaner across three assessments than NA youth. However, age‐and‐sex‐adjusted BMI increased faster in PI youth. Psychosocial stress during puberty predicted greater age‐and‐sex‐adjusted BMI, but this effect did not differ by group. The gap in BMI but not height appears to close between PI and NA youth. Higher psychosocial stress was associated with higher BMI during puberty.
... Research has amply demonstrated many short-and long-term harms associated with child neglect (Kobulsky & Dubowitz, 2021a). It is also evident that there is much variation in outcomes and many children and adults appear to be resilient, functioning well (e.g., Le Mare & Audet, 2006;Sonuga-Barke et al., 2017). Resilience is however clearly a relative concept; few emerge from severe neglect unscathed. ...
This commentary highlights several challenges concerning the conceptualization of child neglect and the approach to this prevalent problem, with the goal of stimulating further thought and hopefully action. Examples include consideration of potential harm, the role of culture, intentionality, and new forms of neglect related to new knowledge of children’s needs. Assessment of possible neglect, interviewing children, use of motivational interviewing, and the importance of identifying families’ strengths are additional issues. Finally, the commentary addresses alternative response systems, resilience, prevention, and advocacy. We suggest ways to tackle these challenges.
... Children from low-and middle-income countries tend to be stunted and underweight [17]. Some studies have shown the presence of growth retardation in orphans living in orphanages, with an improvement in their nutritional status achieved only after they were adopted by families [18] [19]. Results of the current study show that improvement in nutritional status can be achieved by other means, and not only after adoption. ...
... and Western Europe (Miller & Hendrie, 2000;Reid et al., 2017;Rutter, 1998;Van IJzendoorn et al., 2007). However, once removed from deprivation and placed in families, children adopted from orphanage-like institutions exhibit rapid catchup growth and are typically within normal anthropometric parameters for age within a year of adoption or fostering (Le Mare & Audet, 2006;Miller et al., 2010;Palacios et al., 2014;Pomerleau et al., 2005;Van IJzendoorn et al., 2007). ...
... Institutional rearing may not impact cardiometabolic and immune markers in a manner similar to that observed for other adverse childhood exposures. For example, prior research on children with histories of institutional care (14,100) has not found evidence for earlier pubertal onset, which is consistently observed among children exposed to adversities characterized by threat (e.g., violence, abuse) (101)(102)(103)(104). This distinction suggests that although some forms of adversity may accelerate processes linked to aging (e.g., pubertal timing (101-104), accelerated telomere erosion (105,106), and elevated inflammation (34)), institutionalization may be associated with delayed or atypical neurobiological development as the result of nutritional insufficiencies and growth hormone deficiencies (15,60,107), which could influence synaptic development (108), and thus a range of downstream outcomes. ...
Objective:
Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. We compared the consequences of long-term, high-quality foster care versus standard institution-based care, which began in early childhood on cardiometabolic and immune markers assessed at the time of adolescence.
Methods:
The Bucharest Early Intervention Project is a longitudinal investigation of children institutionalized during early childhood (ages 6 to 30 months at baseline) who were subsequently randomized to either high-quality foster care or continued institutional care. At the age of 16 years, 127 respondents participated in a biomarker collection protocol, including 44 institutionalized children randomly assigned to receive care as usual, 41 institutionalized children randomized to be removed from institutional care and placed in high-quality foster care in infancy, and a control group of 42 demographically matched children raised in biological families. Outcomes included body mass index (BMI), systolic and diastolic blood pressure, C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, glycosylated hemoglobin A1c, and Epstein-Barr virus antibody titers.
Results:
Early institutional rearing was not associated with differences in cardiometabolic or immune markers. Randomization to foster care and age of placement into foster care were also unrelated to these markers, with the exception of BMI z-score, where children assigned to care as usual had lower BMI z-scores relative to children assigned to foster care (-0.23 versus 0.08, p = .06), and older age at placement was associated with lower BMI (β = -0.07, p = .03).
Conclusions:
The impact of institutional rearing on measures of cardiometabolic health and immune system functioning is either absent or not evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type.
Clinical trial registration:
NCT00747396.
... 2 Catch-up growth is observed in the few longer-term longitudinal studies with assessments into middle childhood to early adolescence, as height and weight of most adoptees are comparable to standardized means of growth charts and/or typical children. 1,[3][4][5] Although considered a positive improvement for adoptees, rapid catch-up growth can contribute to risk for overweight/obesity and related health problems in later adolescence and adulthood. [6][7][8] Rapid catch-up growth, often observed in babies born at low birth weight and growth-stunted children who experience significant weight gain, is a risk for obesity, type two diabetes, hypertension, and coronary heart disease in adulthood. ...
... 8,[15][16][17][18][19] Previous work by our group has shown that Romanian children with a history of institutionalization randomized to foster care (FCG) show significant catch-up growth compared to controls who received care as usual (CAUG), 1 consistent with longitudinal observations in post-institutionalized youth. [3][4][5] However, no studies have examined relations between patterns of catch-up growth and metabolic and inflammatory biomarkers in late adolescence among post-institutionalized adolescents. Of note, inflammation plays a role in the pathogenesis of obesity and diabetes, which have been linked to elevated levels in a cluster of low-grade pro-inflammatory cytokines, including interleukin (IL)-6, tumor necrosis factor (TNF)-α, and c-reactive protein (CRP; an acute phase protein released in the liver in response to systemic inflammation). ...
Background:
Reduced prenatal growth followed by rapid postnatal weight gain are risk factors for developing metabolic and cardiovascular disease. Children reared in institutions experience a similar pattern of growth restriction followed by catch-up growth after removal. We explored whether patterns of catch-up growth affect metabolic and cardiovascular outcomes in previously institutionalized adolescents.
Method:
A longitudinal study of institutionalized infants randomized to care as usual (n = 68) or foster care intervention (n = 68), and never institutionalized controls (n = 127). Body mass index (BMI) was measured at baseline (20 months), 30, 42 months, and ages 8, 12, 16. At age 16, metabolic and pro-inflammatory markers were derived from blood samples.
Results:
Four BMI trajectories were derived (i.e., average-stable, low-stable, elevated, and accelerated). The accelerated trajectory was comprised predominately of children randomized to foster care, who also exhibited higher levels of glycosylated hemoglobin and C-reactive protein than the other three trajectories. Also, children placed in foster care at younger ages were more likely to be on the accelerated rather than the average-stable trajectory.
Conclusions:
Although catch-up growth is viewed as a positive improvement among post-institutionalized children, rapid/continuous increases in body size pose a health concern. Attention should be given to monitoring weight gain, diet, and physical activity.
... The findings were mixed. In some studies, preadoption adversity continued to be associated with the adoptees'adjustment in early adolescence and adolescence (e.g., Beckett et al., 2006;Le Mare & Audet, 2006). In other studies, preadoption experiences lost their predictive power after the IA children reached adolescence (e.g., Verhulst & Versluis-den Bieman, 1995). ...
Internationally adopted (IA) children often have delays at adoption and undergo massive catch-up after adoption. Before achieving developmental catch-up, however, delays at adoption present a risk for IA children's adjustment, but it remains unknown whether such delays foreshadow IA children's outcomes after catch-up development has completed or ceased. In the current analysis, we utilized menarche as a practical marker to indicate the cessation of developmental catch-up. We investigated how delays at arrival predicted long-term outcomes in 132 postmenarcheal teens (M = 14.2 years, SD = 1.7) who were adopted from China at 16.6 months (SD = 17.1). In 2005, adoptive parents provided data of medical evaluation results on their children's delay status in gross motor skills, fine motor skills, social development, emotional development, and cognitive development. Six years later in 2011, data on parent-child relationship quality were collected from parents, and data on the adoptees' academic competence and internalizing problems were also collected from both parents and adoptees. We found that gross motor delay at arrival predicted academic performance (parent-report: b = -.34, p < .01) and internalizing problems (self-report: b = .26, p < .05; parent-report: b = .33, p < .01). Other delays were not significant in predicting any of the outcomes. The impact of early nutritional deprivation on gross motor development was discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
... Children were removed from institutional care in Romania in the early 1990s, before any reforms had been instituted there, and then placed in advantaged homes with adoptive parents in the United Kingdom. Other studies of children adopted out of institutions also have made important contributions (e.g., LeMare & Audet, 2006;Morison & Ellwood, 2000;Tarullo, Bruce, & Gunnar, 2007;Verhulst, Althaus, & Versluis-Den Bieman, 1990;Vorria et al., 2003). ...
This chapter reviews sensitive periods in human brain development based on the literature on children raised in institutions. Sensitive experiences occur when experiences are uniquely influential for the development of neural circuitry. Because in humans, we make inferences about sensitive periods from evaluations of complex behaviors, we underestimate the occurrence of sensitive periods at the level of neural circuitry. Although we are most interested in complex behaviors, such as IQ or attachment or externalizing problems, many different sensitive periods at the level of circuits probably underlie these complex behaviors. Results from a number of studies suggest that across most, but not all, domains of development, institutional rearing limited to the first 4-6 months of life is associated with no significant increase risk for long-term adverse effects relative to noninstitutionalized children. Beyond that, evidence for sensitive periods is less compelling, meaning that "the earlier the better" rule for enhanced caregiving is a reasonable conclusion at the current state of the science.
... Early deprivation and home basal cortisol levels: a study of internationally-adopted children, in preparation) (N ϭ 3437) for height after some years of adoption. We found 24 outcomes 27,37-41,43-46,49 -56,64,65 (Román M, Palacios J, Sánchez-Sandoval Y, León, E. Physical development in children adopted internationally: development at arrival and later recovery, in preparation) (N ϭ 3753) for weight at adoptive placement, and 18 outcomes 27,37,39,41,50,[54][55][56][60][61][62]66 (Román M, Palacios J, Sánchez-Sandoval Y, León, E. Physical development in children adopted internationally: development at arrival and later recovery, in preparation) (N ϭ 3259) for weight later. For information on head circumference at adoptive placement, we found 15 outcomes 14,[37][38][39][40][43][44][45][51][52][53]56 (N ϭ 1331), and six outcomes 14,37,39,56,66 (Román M, Palacios J, Sánchez-Sandoval Y, León, E. Physical development in children adopted internationally: development at arrival and later recovery, in preparation) on head circumference at a later point in time (N ϭ 527). ...
Are serious growth delays caused by malnutrition and neglect permanent or reversible? The effects of institutionalization and international adoption on children's physical growth are estimated with meta-analysis. Studies with sufficient data to compute differences between adoptees and the reference population (33 papers with 122 study outcomes) were collected through Web of Science, ERIC (Education Resource Information Center), PsycINFO (Psychological Literature), and Medline (U.S. National Library of Medicine) (1956-2006). The influence of pre- and postadoption care on height, weight, and head circumference was tested. Effect sizes (d) and confidence intervals (CIs) around the point estimate for the growth lag indices were computed. The more time spent in institutional care, the more the children lagged behind in physical growth (d = 1.71, 95% CI: 0.82-2.60, n = 893). At adoptive placement, the children showed large delays in height, weight, and head circumference (d = -2.39 to -2.60; n = 1331-3753). Although after adoption, they showed almost complete catch-up of height (d = -0.57, 95% CI: -0.87 to -0.27, n = 3437 adoptees) and weight (d = -0.72, 95% CI: -1.04 to -0,39, n = 3259 adoptees), catch-up of head circumference seemed slower and remained incomplete (d = -1.56, 95% CI: -2.27 to -0.85, n = 527). Later age at arrival was related to less complete catch-up of height and weight. International adoption leads to substantial catch-up of height and weight but not of head circumference, demonstrating differential plasticity of children's physical growth.
... These children have now been assessed three times -at 11 months post-adoption, at 4.5 years of age, and at 10.5 years of age. Findings to date reveal that at all three phases, the Romanian orphanage children have experienced a higher rate of problems in all domains assessed than have children in two matched comparison groups, Canadian-born non-adopted children and children adopted from Romania in early infancy (Ames, 1997;Fernyhough, Audet, & Le Mare, 2002;Kurytnik, 2003;Le Mare & Audet, 2006;Le Mare & Kurytnik, 2002;Le Mare, Warford, & Fernyhough, 2001). ...
... In the case of both the RO and EA groups, pre-and peri-natal care was lacking, and early rearing conditions were at best characterized by poverty and a lack of access to medical attention and at worst by extreme global deprivation. The RO children in particular, spent many months or years living in often crowded and unsanitary conditions, deprived of nutrition and medical care, which certainly took a toll on their physical health (see Le Mare & Audet, 2006). In North America, one would be hard pressed to find children so lacking in physical care, particularly if they were already in the social welfare system as many pre-adoption special needs adoptees are. ...
... Examination of service use within the RO and EA groups over time indicates that the specific nature of services used has changed with the developmental needs of the children. In the RO group, services used for physical health have decreased longitudinally, likely as a result of medical issues being resolved (see Le Mare & Audet, 2006). In the behavioral domain, the relatively large increase in service use at Phase 3 may be explained by the increase in externalizing problems and school entry. ...
Post-adoption service use and unmet service needs were examined longitudinally in three matched groups of children: children adopted from Romanian orphanages following a minimum of eight months' institutional experience (RO: n = 36); children from Romania who were destined for orphanages but were adopted early in infancy (EA: n = 25); and Canadian born non-adopted children (CB: n = 42). Data were collected when the adoptees had been in their adoptive homes for 11 months, at age 4.5 years and 10.5 years. Results indicated higher rates of service use and unmet service needs across time in the RO group. Unmet service needs in the RO group may be due in part to the unique challenges faced by post-institutionalized adoptees. Service use in the EA group jumped significantly at Phase 3, suggesting that the impact of their lesser degree of early deprivation was seen later in development under the additional challenge and stress of the demands of school. Findings, particularly from the EA group, supported the suggestion that adoptive parents have a lower threshold for referring their children for clinical services than do non-adoptive parents. Service needs of adoptees changed over time and those with unmet needs experienced greater challenges than those whose service needs were met.
