Alterations in Neural Processing and Psychopathology in Children Raised in Institutions

Context: Young children raised in institutional settings experience severe deprivation in social, emotional, and cognitive stimulation. Although this deprivation is likely to disrupt brain development in ways that increase the risk for psychopathology, neurodevelopmental mechanisms linking adverse early environments to psychopathology remain poorly understood. Objective: To examine whether abnormalities in the neural processing of facial and emotional stimuli are related to the high rates of psychopathology observed among institutionally reared children. Design, Setting, and Participants: Data were drawn from the Bucharest Early Intervention Project, a cohort of children raised in institutions in Romania and an age-matched sample of community control subjects. At entry to the study (mean age, 22 months), event-related potentials were used to measure neural processing in 2 tasks: familiar and unfamiliar faces (n = 114) and facial displays of emotion (n = 74). Main Outcome Measures: Psychiatric symptoms were assessed using the Preschool Age Psychiatric Assessment among children aged 54 months. Results: As previously reported, institutionally reared children had elevated symptoms of attention-deficit/ hyperactivity disorder (ADHD), anxiety, depression, and disruptive behavior compared with control children, and peak amplitudes of the P100 and P700 in response to facial stimuli were blunted among institutionalized children compared with community children in both tasks. Current analyses reveal that children with reduced P100 and P700 amplitudes in response to facial stimuli exhibited higher levels of ADHD and anxiety symptoms. Peak amplitude of the P700 in response to facial stimuli significantly mediated the association between institutional rearing and ADHD symptoms at 54 months. Conclusion: Exposure to institutional rearing disrupts the P700, conferring risk for the onset of psychopathology. The high levels of ADHD symptoms among children exposed to early life deprivation may be attributable, in part, to abnormal patterns of neurodevelopment generated by these adverse rearing environments. Arch Gen Psychiatry. 2012; 69(10): 1022-1030. Published online June 4, 2012. doi: 10.1001/archgenpsychiatry.2012.444