Charles H Zeanah

• MD
• Professor at Tulane University

Ethics is concerned with the basis for moral judgments of "right" and "wrong" and is central to the clinical endeavor. Many clinicians integrate ethical estimations into their work without much conscious awareness. However, explicit use of ethical principles and frameworks can help navigate clinical decision-making when there is a sense of moral co...

We examined whether family care following early-life deprivation buffered the association between stressful life events (SLEs) and executive functioning (EF) in adolescence. In early childhood, 136 institutionally reared children were randomly assigned to foster care or care-as-usual; 72 never-institutionalized children served as a comparison group...

Hypotheses concerning the biologic embedding of early adversity via developmental neuroplasticity mechanisms have been proposed on the basis of experimental studies in animals. However, no studies have demonstrated a causal link between early adversity and neural development in humans. Here, we present evidence from a randomized controlled trial li...

This study examined longitudinal data from the Bucharest Early Intervention Project, a randomized controlled trial of foster care as an alternative to institutional care following exposure to severe psychosocial deprivation. We report data from 135 participants assessed in early adulthood (age 18 y). We find that 16 y after randomization occurred,...

Childhood neglect is associated with impairment across multiple domains of development. Because types of neglect co-occur and are correlated with abuse, most research cannot address the specific effects of psychosocial neglect. This limitation matters because some scholars have advocated that child protection measures should be employed only when a...

Institutional rearing negatively impacts the development of children's social skills and executive functions (EF). However, little is known about whether childhood social skills mediate the effects of the foster care intervention and foster caregiving quality following early institutional rearing on EF and social skills in adolescence. We examined...

In molti contesti professionali, compreso quello del Tribunale per i minorenni, si fa riferimento alla teoria dell'attaccamento e alla relativa ricerca, con fraintendimenti ampiamente diffusi che spesso si traducono in applicazioni scorrette. La finalità di questa dichiarazione di consenso è, pertanto, quella di migliorarne la comprensione, contras...

Over the last 20 years, we have learned much about the extent to which early‐life deprivation affects the mental health of children and adolescents. This body of evidence comes predominantly from studies of children raised in institutional care. The Bucharest Early Intervention Project (BEIP) is the only randomized controlled trial designed to eval...

Objective: The COVID-19 pandemic and mitigation strategies amplified racial and income-based health disparities, profoundly shifted family life, and altered delivery systems for support services. We report pilot data from a telehealth adaptation of Mom Power, an evidence-based, attachment-informed multifamily preventive intervention (clinicaltrial...

La théorie et les recherches sur l’attachement sont utilisées dans de nombreux cadres d’application, y compris dans les tribunaux compétents en matière familiale [1], mais les incompréhensions sont fréquentes et sources d’erreurs lorsqu’il s’agit de les mettre en pratique. L’objectif de cet article de consensus est donc d’accroître la compréhension...

La teoría y la investigación sobre el apego se utilizan en muchos contextos aplicados, incluidos los juzgados de familia, pero hay malentendidos muy extendidos y que a veces dan lugar a aplicaciones erróneas. El objetivo de este documento de consenso es, por lo tanto, mejorar la comprensión, contrarrestar la desinformación y dirigir el uso de la te...

Autonomic nervous system reactivity has been posited to be a mechanism contributing to social and emotional problems among children exposed to early adversity. Leveraging data from the Bucharest Early Intervention Project, a longitudinal randomized controlled trial of foster care versus institutional care of abandoned children in Romania, we assess...

Homer's Odysseus was forced to sail through a straight between 2 terrifying monsters: Charybdis, a giant whirlpool that threatened to devour the ship and crew, and Scylla, a 6-headed monster with rows of sharklike teeth who devoured men whole if they came within her grasp. Similar to Odysseus, clinicians who are treating maltreated children and the...

Background: Experiences of adversity in early life are associated with increased risk for negative outcomes; yet, the impact of early adversity on any given child is difficult to predict given the considerable heterogeneity in functioning found even among children with similar exposures. Thus, although early adversity is associated with increased...

This study examined whether early institutional rearing and attachment security influence the quality and quantity of friendships at age 16 in 138 participants, including children abandoned to institutions in Bucharest, Romania, who were randomized to care as usual (n=45, 26 female), or foster care (n=47, 25 female), and a never-institutionalized g...

Children reared in institutions experience severe psychosocial deprivation, resulting in lasting consequences for social and emotional development. This study evaluated growth trajectories of self-regulation from ages 8 to 16 among previously institutionalized children randomized to foster care (foster-care group; FCG) or to remain in institutional...

Objective: Early psychosocial deprivation increases the risk of later cognitive and psychiatric problems, but not all deprived children show these difficulties. Here, we examine the extent to which psychosocial deprivation increases the risk of later cognitive and psychiatric difficulties and the downstream consequences of this for risk-taking beha...

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, e...

Background The quality of early caregiving experiences is a known contributor to the quality of the language experiences young children receive. What is unknown is whether, and if so, how psychosocial deprivation early in life is associated with long-lasting receptive language outcomes. Methods Two prospective longitudinal studies examining early...

Objective: Early psychosocial deprivation is associated with increased risk for psychopathology, yet few studies have examined outcomes in adolescents. Method: At baseline (M age 22 months), 136 children from Bucharest, Romania, living in large institutions, were randomized into foster care (FCG) or to care as usual (CAUG). Caregivers completed...

Early adversity has been shown to sensitize individuals to the effects of later stress and enhance risk of psychopathology. Using a longitudinal randomized trial of foster care as an alternative to institutional care, we extend the stress sensitization hypothesis to examine whether early institutional rearing sensitizes individuals to stressful eve...

Children who spend their early lives in institutions experience profound psychosocial deprivation that is associated with altered stress response system development. Here, we used data from a longitudinal randomized controlled trial of foster care for institutionally reared children to examine whether caregiving quality and stressful life events (S...

Background Adolescence has been proposed to be a period of heightened sensitivity to environmental influence. If true, adolescence may present a window of opportunity for recovery for children exposed to early‐life adversity. Recent evidence supports adolescent recalibration of stress response systems following early‐life adversity. However, it is...

Crying represents a powerful signal for human newborns. How parents should respond has been a matter of debate, with some urging prompt responding and others expressing concern about spoiling. Despite the fervor of the debate, few longitudinal observational studies have addressed the question. A new study in this issue by Bilgin and Wolke provides...

Knowledge and understanding about the impact of cumulative adverse experiences on the health and wellbeing of children, adolescents, and adults has rapidly expanded over the past 30 years. Despite the invaluable attention and support this proliferation has drawn to the importance of early childhood experiences, we believe that it is time to move be...

Worldwide, millions of children live in institutions, which runs counter to both the UN-recognised right of children to be raised in a family environment, and the findings of our accompanying systematic review of the physical, neurobiological, psychological, and mental health costs of institutionalisation and the benefits of deinstitutionalisation...

Children that have experienced psychosocial neglect display impairments in self-monitoring and controlling their behavior (cognitive control) and are at broad, transdiagnostic risk for psychopathology. However, the neural underpinnings of such effects remain unclear. Event-related mediofrontal theta oscillations reflect a neural process supporting...

Background Children reared in institutions experience profound deprivation that is linked to impairments in social communication (SC). However, little is known about the long‐term consequences of institutional rearing on SC through adolescence, and how SC deficits relate to broad‐spectrum psychopathology. It is also unclear whether early removal fr...

Adverse developmental outcomes for some children following institutional care are well established. Removal from institutional care and placement into families can promote recovery. However, little is known about how positive outcomes are sustained across adolescence among children with histories of severe deprivation. The present study examined th...

Childhood adversity may sensitize certain individuals to later stress which triggers or amplifies psychopathology. The current study uses data from a longitudinal randomized controlled trial to examine whether severe early neglect among children reared in institutions increases vulnerability to the effects of later stressful life events on external...

A study by Allen and Schuengel in this issue of the journal replicates and extends previous findings by Woolgar and Baldock (2015) indicating that community practitioners are far more likely to diagnose reactive attachment disorder in symptomatic children than are specialists using well‐validated measures. We consider historic variability in how th...

This issue of the Journal provides an extraordinarily rich array of timely and important investigations on topics ranging from psychotic symptoms in adolescents to several types of neurodevelopmental disorders to brain structure in young children with sleep disturbances. Papers feature longitudinal studies, a meta‐analysis, and intervention researc...

Background Children reared in institutions experience profound deprivation that is associated with both heightened levels of psychopathology and deficits in executive functioning (EF). It is unclear whether deficits in EF among institutionally-reared children serve as a vulnerability factor that increases risk for later psychopathology. It is also...

Background: There has been mounting interest in the pathophysiological relation between inflammation and psychopathology. In this paper, we examined associations between internalizing and externalizing psychopathology and inflammation in adolescents with a history of severe psychosocial deprivation and children reared in typical family contexts....

Hurricane Katrina struck the southern coast of the United States on August 31, 2005. This Category 5 hurricane was one of the worst disasters in American history. Here, we review the background and context of Katrina, the costliest ($125 billion) hurricane to ever hit the United States, emphasizing the complex series of traumatic events encompassed...

Exposure to early psychosocial deprivation as a result of institutional care disrupts typical brain development. The Bucharest Early Intervention Project (BEIP) is the first longitudinal study to investigate the neurodevelopment of institutionalized infants randomized to a foster care (FCG) intervention versus care as usual (CAUG). Here, we present...

Psychosocial deprivation is associated with the development of socially aberrant behaviors, including signs of disinhibited social engagement disorder (DSED). In longitudinal studies, signs of DSED have been shown to decrease over time, especially as children are removed from conditions of deprivation. What is less clear is whether signs of DSED in...

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: T...

Objective: Telomere length (TL) has been linked to several psychiatric conditions in children and adults. Telomere shortening is accelerated by early adversity, including maltreatment and psychosocial deprivation. These experiences also increase the risk of psychopathology in many domains. Two fundamental issues remain unresolved. The first concer...

Background: Institutional rearing is associated with increased risk for reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). Disorders of attachment involve disturbances in children’s primary caregiving relationships, and are likely to disturb multiple domains of social functioning. Objective: To examine associati...

Experience plays an essential role in building brain architecture after birth. The question we address in this paper is what happens to brain and behavior when a young child is deprived of key experiences during critical periods of brain development. We focus in particular on the consequences of institutional rearing, with implication for the tens...

Children experiencing psychosocial deprivation as a result of early institutional rearing demonstrate many difficulties with memory and executive functioning (EF). To date, there is scant evidence that foster care placement remediates these difficulties during childhood. The current study examined longitudinal trajectories of memory and EF from chi...

Infant mental health is considered synonymous with healthy social and emotional development. Important indicators of infant mental health include the young child’s capacity for emotion regulation, ability to communicate feelings to caregivers, and active exploration of the environment. These behaviors lay the groundwork for later social and emotion...

Unusual social behaviors have been central to our notions of autism spectrum disorders since their original descriptions. We have come to recognize that such behaviors are broadly distributed beyond the classic phenotype and may be induced by postnatal experiences involving insufficient care. Sex differences have also been noted, and a paper in the...

Acute reactivity of the stress hormone cortisol is reflective of early adversity and stress exposure, with some studies finding that the impact of adversity on the stress response differs by race. The objectives of the current study were to characterize cortisol reactivity to two dyadically based stress paradigms across the first year of life, to e...

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 cardiova...

This study examined disruptions in caregiving, as well as the association of these disruptions, with cognitive, behavioral, and social outcomes at age 12 in a sample of 136 Romanian children who were abandoned to institutions as infants and who experienced a range of subsequent types of care. Children were found to experience significantly more car...

Importance It is unclear whether early institutional rearing is associated with more problematic trajectories of psychopathology from childhood to adolescence and whether assignment to foster care mitigates this risk. Objectives To examine trajectories of latent psychopathology factors—general (P), internalizing (INT), and externalizing (EXT)—amon...

Risk-taking in adolescence has been often associated with early life adversities. However, the impact of such macrolevel factors on risk behavior has been rarely studied in humans. To address these gaps we recruited a sample of young adolescents who were part of a randomized control trial of foster care. Children institutionalized at or soon after...

The adverse effects of institutionalized care and psychosocial deprivation have been documented for more than 100 years. Children who have been raised in institutions are at heightened risk of developing internalizing and externalizing disorders. Given the profound biological and psychological effects of institutional rearing, identifying neural an...

Physical, sexual, and emotional abuse and various forms of neglect of children are associated with substantially increased risk for concurrent and subsequent psychopathology and are among the common problems encountered by clinicians in many clinical settings. Such cases pose additional challenges for clinicians because of the many complex family a...

Objectives: To determine the effects of foster care vs institutional care, as well as disruptions in the caregiving environment on physical development through early adolescence. Study design: This was a randomized controlled trial of 114 institutionalized, though otherwise healthy, children from 6 orphanages and 51 never institutionalized contr...

Although the study of reactive attachment disorder (RAD) in early childhood has received considerable attention, there is emerging interest in RAD that presents in school age children and adolescents. We examined the course of RAD signs from early childhood to early adolescence using both variable-centered (linear mixed modeling) and person-centere...

Exposure to psychosocial deprivation is associated with elevations in numerous forms of impairment throughout the life-course. Disruptions in associative learning may be a key mechanism through which adversity, particularly psychosocial deprivation, increases risk for impairment. Existing data consistent with this claim come entirely from correlati...

Institutional rearing is associated with deficits in executive functions, such as inhibitory control, and may contribute to later externalizing behavior problems. In the current study, we explored the impact of institutional rearing on attention in the context of inhibiting a planned action. As part of the Bucharest Early Intervention Project (BEIP...

The JCPP works at the cutting edge of clinical science to publish ground‐breaking research across the full range of topics in the field of child psychology and psychiatry. As JCPP editors, who are also active researcher's in our own right, we are conscious of the threat posed to our field by what has come to be known as the reproducibility crisis ‐...

Brain development in the early years is especially susceptible to toxic stress caused by adverse childhood experiences (ACEs). According to epigenetics research, toxic stress has the capacity to physically change a child’s brain and be hardwired into the child’s biology via genes in the DNA. The compelling nature of the impact of early adversity on...

Objective Disinhibited social engagement disorder (DSED) is poorly understood beyond early childhood. In a sample of children who experienced severe, early deprivation, we examined the course of DSED signs from early childhood to early adolescence using variable-centered (linear mixed modeling) and person-centered (growth mixture modeling) approach...

Background: Experiences in early life lay the foundation for later development and functioning. Severe psychosocial deprivation, as experienced by children in early institutional care, constitutes an adverse experience with long-term negative consequences. The Bucharest Early Intervention Project sought to examine the effects of foster care as an...

We examined facial emotion recognition in 12-year-olds in a longitudinally followed sample of children with and without exposure to early life psychosocial deprivation (institutional care). Half of the institutionally reared children were randomized into foster care homes during the first years of life. Facial emotion recognition was examined in a...

The absence of typical caregiving, including warm and responsive parenting, has been suggested to significantly affect the young child's ability to form adaptive relationships with adults and peers. The Bucharest Early Intervention Project (BEIP), a randomized controlled trial of foster/family care for young children with a history of institutional...

There is often a gap between politics and science, but the influence across the gap is bidirectional. This editorial considers a longitudinal, community-based sample of children and adolescents and asks about risks from early childhood gender non-conformity and adolescent reported sexual minority status for subsequent anxiety disorders. It is espec...

We examined visual recognition memory and executive functioning (spatial working memory [SWM], spatial planning, rule learning, and attention shifting) in 12-year-olds (n = 150) who participated in the Bucharest Early Intervention Project, a randomized controlled trial of foster care for institutionally reared children. Similar to prior reports at...

The Bucharest Early Intervention Project (BEIP) is the only randomized controlled trial of foster care for children who were abandoned at or shortly after birth and placed into institutional care. The study conducted careful pre-randomization assessments at a mean age of 22 months and has included follow-ups through mid-adolescence. This longitudin...

Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that...

The brain's neural circuitry plays a ubiquitous role across domains in cognitive processing and undergoes extensive re-organization during the course of development in part as a result of experience. In this paper we investigated the effects of profound early psychosocial neglect associated with institutional rearing on the development of task-inde...

Early psychosocial deprivation has profound adverse effects on children's brain and behavioural development, including abnormalities in physical growth, intellectual function, social cognition, and emotional development. Nevertheless, the domain of emotional face processing has appeared in previous research to be relatively spared; here, we test fo...

Decades of research on child development confirms that children develop best in the context of safe, supportive, nurturing relationships.1 Positive relationships with primary caregivers are essential for children’s healthy physical and emotional development. For children who experience serious traumas, parents provide an essential protective shield...

Two disorders of attachment have been consistently identified in some young children following severe deprivation in early life: reactive attachment disorder and disinhibited social engagement disorder. However, less is known about whether signs of these disorders persist into adolescence. We examined signs of reactive attachment disorder and disin...