Autism-like behaviors, impaired nerve tracts found in institutionalized children

Sad child-shutterstock_92102072 croppedThe sad experience of abandoned children in Romanian orphanages continues to provide stark lessons about the effects of neglect and deprivation of social and emotional interactions. The long-running Bucharest Early Intervention Project (BEIP) has been able to transfer some of these institutionalized children, selected at random, into quality foster care homes—and documented the benefits.

In a review article in the January 29 Lancet, BEIP investigator Charles A. Nelson, PhD, and medical student Anna Berens, MsC, both of Boston Children’s Hospital, make a strong case for global deinstitutionalization—as early in a child’s life as possible. Currently, it’s estimated that at least 8 million children worldwide are growing up in institutional settings.

The BEIP studies have documented a series of problems in institutionalized children, especially those who aren’t placed in foster care or are placed when they are older:

Most recently, in the February Journal of the American Academy of Child and Adolescent Psychiatry, the BEIP team reports that children abandoned to institutional care are at increased risk for behaviors resembling those in children with autism, including impaired social communication. When the institutionalized children were moved into child-centered foster care at a young age, their social behaviors improved.

In a related study, published January 26th in JAMA Pediatrics, the team found that children who stayed in institutional care had impaired development of specific tracts of white matter when examined with diffusion tensor imaging, an MRI technique. The defects affected circuits involved in emotion, language processing, attention, executive function and general cognition. However, in children removed from the orphanage before the age of 2, tracts appeared closer to normal when they were imaged later in childhood.

Recent neuroscience research in children with autism from the general population has also found differences in brain wiring and function. But lest anyone be thinking “refrigerator mothers,” the BEIP researchers are quick to dispel any blanket notion that parents are to blame for autism.

“Although the institutionalized children with autism resemble children with autism in the general population, the origins of their symptoms are very different,” says Nelson, a senior investigator on BEIP’s two recent studies and author of Romania’s Abandoned Children. “We believe that both groups suffer deprivation, but of different types: In institutionalized children, the deprivation comes from their environment, while in the general population, the autism itself causes a kind of deprivation, making it harder for children to perceive and understand social cues.”