Children raised in institutions have impaired memory and executive functioning at age 16

long-term effects of child institutionalization

An estimated 8 million children worldwide live in institutions where they experience neglect and deprivation. Last fall, a study of children reared in Romanian orphanages reported high levels of mental health problems when they reached adolescence. In particular, they had more difficult behaviors such as rule-breaking, excessive arguing with authority figures, stealing or assaulting peers. But if they were placed early with carefully vetted foster families through the Bucharest Early Intervention Project (BEIP) , these problems were reduced.

A new BEIP study, published yesterday in the Proceedings of the National Academy of Sciences, examined cognitive functioning. It found that institutionalized children, at ages 8 and 16, also have impaired memory and executive functioning compared with peers placed early in foster homes.

“Executive functioning includes several cognitive processes that help people be more goal-oriented and solve problems,” explains study leader Mark Wade, PhD, of the Division of Developmental Medicine at Boston Children’s Hospital. “It is important in academic achievement and social functioning in childhood, and is related to long-term occupational attainment, income and other aspects psychosocial well-being.”

The toll of neglect and deprivation

Children in all study groups, institutionalized or not, improved on several measures of memory and executive functioning as they got older. But among those who were institutionalized, early impairments in certain components of executive functioning (attention, short-term visual memory, spatial planning, problem solving) persisted through adolescence. This was true even for those eventually placed with foster families. For one measure, spatial working memory (the ability to retain and manipulate spatial and visual information), the gap widened by adolescence between children who had ever been institutionalized and those who hadn’t.

A safe, nurturing and cognitively stimulating environment in a family-based setting is critical to children’s long-term success.

But there was one note of hope. When young institutionalized children were placed in quality foster care, early difficulties in visual-spatial memory and new learning diminished by adolescence. By age 16, they were indistinguishable from other children on those measures.

“Institutionally-reared children start out with more difficulties,” says Wade. “But when they are assigned early to positive caregiving environments, they may demonstrate some catch-up on certain aspects of executive functioning. A safe, nurturing and cognitively stimulating environment in a family-based setting is critical to children’s long-term success. It may help some who struggle early get back on track during adolescence, an important period of social and biological development.” 

EEG predictor?

The study also found that an EEG measure of brain activity at age 8, namely higher resting EEG alpha power, predicted better executive functioning at ages 8, 12, and 16.

“This may point to a neural mechanism that supports children’s cognitive development,” says senior study author Charles A. Nelson, PhD, director of the Laboratories of Cognitive Neuroscience at Boston Children’s.

Nathan A. Fox of the University of Maryland and Charles H. Zeanah of Tulane University School of Medicine were coauthors on the paper. The study was funded by the John D. and Catherine T. MacArthur Foundation, the Binder Family Foundation, the National Institute of Mental Health and a Banting postdoctoral fellowship.