Romania’s Abandoned Children

Deprivation, Brain Development, and the Struggle for Recovery

Charles A. Nelson, Nathan A. Fox, Charles H. Zeanah

• Publisher: Harvard University Press
• Year: 2014
• Print ISBN:
  9780674724709
• eBook ISBN:
  9780674726994
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

The implications of early experience for children's brain development, behavior, and psychological functioning have long absorbed caregivers, researchers, and clinicians. The 1989 fall of Romania's Ceausescu regime left approximately 170,000 children in 700 overcrowded, impoverished institutions across Romania, and prompted the most comprehensive study to date on the effects of institutionalization on children's wellbeing. Romania's Abandoned Children, the authoritative account of this landmark study, documents the devastating toll paid by children who are deprived of responsive care, social interaction, stimulation, and psychological comfort.

Launched in 2000, the Bucharest Early Intervention Project (BEIP) was a rigorously controlled investigation of foster care as an alternative to institutionalization. Researchers included 136 abandoned infants and toddlers in the study and randomly assigned half of them to foster care created specifically for the project. The other half stayed in Romanian institutions, where conditions remained substandard. Over a twelve-year span, both groups were assessed for physical growth, cognitive functioning, brain development, and social behavior. Data from a third group of children raised by their birth families were collected for comparison.

The study found that the institutionalized children were severely impaired in IQ and manifested a variety of social and emotional disorders, as well as changes in brain development. However, the earlier an institutionalized child was placed into foster care, the better the recovery. Combining scientific, historical, and personal narratives in a gripping, often heartbreaking, account, Romania's Abandoned Children highlights the urgency of efforts to help the millions of parentless children living in institutions throughout the world.

Chapter 1

The Beginning of a Journey

Let’s begin with a bold premise: that understanding the human brain holds the key to understanding all of human behavior, which in turn may unlock the mysteries surrounding many of the ills that have challenged societies for millennia. But suppose that our ability to understand the adult brain will never be possible unless we first understand brain development—that is, how the two-celled zygote, the product of one sperm and one egg, morphs first into a simple neural tube (which forms just a few weeks after conception) and then into the complex, three-pound organ that in little more than two years from conception propels an infant from a nonverbal being to one who squeals, “No!” while being chased by his mother, who wants to get him into the bath.

Although indirectly this book is about brain development, it is more accurately about how experience—or rather, the lack of experience—impacts the course of brain development and, therefore, child development. It is the story of children abandoned by their parents and reared in state-run institutions. With only modest reframing, it is really about what happens to brains and people when certain fundamental expectations are not met—expectations, for example, that infants and young children will be exposed to sights and sounds (to stimulate hearing and vision), that an adult will comfort them when they need comforting, that adults will talk to them (to teach them language and acknowledge their presence), and that adults will provide the basic care necessary given our inability to take care of ourselves in our youngest years. These needs and responses happen so routinely in typically developing children that we take them for granted. But this story is about children being raised in an environment where responses do not necessarily match needs.

Our understanding of brain development has increased exponentially over the past two decades. These gains can be attributed to advances made in the neurosciences. Animal models have shed light on everything from the genes involved in building a brain to the molecules involved in building a neural circuit. Similarly, our ability to image the living, human brain has expanded by leaps and bounds, to the point that we can now noninvasively peer inside the brain of a newborn during his sleep to examine the brain’s anatomy as well as its electrical and metabolic activity. And, though much remains to be discovered about the details of brain development, we are now in a position to make several assertions with great certainty. First, we know that brains are built over time, beginning a few weeks after conception and continuing through mid-to-late adolescence/early adulthood. Thus, despite the misconception that re-surfaces periodically, brain development does not end at age three.

Second, we know that much as an architect supplies a blueprint for a house, genes supply the initial blueprint for the development of the brain. This genetic plan determines the basic properties of nerve cells as well as the basic rules for interconnecting nerve cells within and across circuits. In this manner, the genetic blueprint sets up the template for brain architecture.

Third, once genes have provided the framework for all subsequent brain development, experience begins to play a critical role in fine-tuning the brain. Although this influence begins prenatally (the effects of prenatal alcohol exposure or maternal stress are just two examples of the effects of experience during the prenatal period), fine-tuning as a result of experience becomes enormously important once a child is born, and it continues through adolescence. The neuroscientist William Greenough proposed two mechanisms by which experience weaves its way into the structure of the brain: experience-expectant development and experience-dependent development.¹

Experience-expectant development refers to the process by which experiences that occur during a narrow window of time early in development have a significant influence on subsequent development. As a rule, these experiences are common to all members of the species and include, for example, access to patterned light (to facilitate visual development), access to faces and speech (to facilitate social communication and language), and access to appropriate caregiving. In contrast, experience-dependent development refers to changes that occur in the brain throughout the lifespan and are unique to each individual. Learning and memory are examples of this form of development.

Finally, we know that the timing of experience plays an essential role in many aspects of brain development, particularly (though not exclusively) those elements that occur after birth.² The principle here, then—a theme carried forward throughout this book—is that of a sensitive period. Specifically, for many brain functions, genes confer basic structure, but because of the limited number of genes (current estimates place this figure at about 20,000), it is advantageous for our adaptation to allow experience to affect gene expression to regulate many elements of brain development, from simple to complex circuits, from sensory cortices to association cortices. Thus genes code for the basics and experience does the fine-tuning. As we will see in the following pages, when this principle is violated, brain development can be undermined, leading to profound alterations in behavioral development.

Politics and Policy

Neuroscientists have known for several decades that brains are built over time, that some domains of development are more dependent on experience than others, and that within those domains the timing of experience is critical to healthy development. This information has not always received the attention it deserves, particularly among policymakers and advocates charged with safeguarding vulnerable children (for example, those seeking to protect children in the child-protection system or children who have been abandoned or orphaned in countries that do not facilitate permanent placements).

On April 17, 1997, President Bill Clinton and First Lady Hillary Rodham Clinton hosted “The White House Conference on Early Childhood Development and Learning: What New Research on the Brain Tells Us about Our Youngest Children.” This conference spurred tremendous interest in the importance of early brain development. However, perhaps because there was only one neuroscientist at the conference or because the media took a simplistic approach to the information, or because the conference coincided with the publication of some recent research on learning, the core messages of brain development were largely misconstrued. For example, a paper published about this time demonstrated that college-age students who listened to Mozart for a few minutes showed short-term improvement in their spatial ability.³ Soon thereafter, the governors of Georgia and Michigan began sending Baby Mozart™ CDs home with new babies, and a multi-million–dollar industry was born, purportedly designed to facilitate infant brain development (think Baby Einstein™). Suddenly, the public was inundated with news articles about so-called critical periods and the “fact” that brain development is “all over” by the age of three. Indeed, in one tongue-in-cheek editorial in the New York Times, a new mother lamented that now that her child was three years old, the toddler’s fate was sealed.⁴

The media coverage that followed the White House conference led to a spirited public discussion about brain development. Some scientists complained that the work discussed at the conference was actually not new at all, but that some of this information had been known for many years.⁵ Others took the information as a call to arms, a challenge to change public policy to ensure that all children had a healthy start in life. Ironically, child development experts had been arguing this same point for decades, but once images of the brain began to appear in the popular press, the need for intervention was given greater weight.

With this background, in 1997 the John D. and Catherine T. MacArthur Foundation expressed interest in supporting interdisciplinary efforts to shed light on the key issues pertaining to early experience and brain development. In February 1998, the foundation formally launched a research network entitled “Early Experience and Brain Development,” which Charles A. Nelson directed and in which Charles Zeanah and Nathan Fox were core members. The study this book details came about as a direct result of this network.⁶

Guiding Principles

The opening position of the group included the following two principles:

1. Experience is the product of an ongoing, reciprocal interaction between the environment and the brain.

2. Individuality is the product of both personal experience and biological inheritance.

Experience

Experience has been defined traditionally by the properties of the environment in which an individual lives. For example, experience might be characterized as exposure to a particular method of teaching or immersion in comfortable, stimulating surroundings. Science tells us, however, that experience is not simply a function of the environment but also the result of a complex, two-way interaction between that environment and the developing brain.

Within this context, the impact of any given experience can vary enormously under identical environmental conditions, depending on the history, maturation, and state of the individual’s brain. For example, listening to a lecture spoken in Chinese will be a completely different experience for a person who understands Chinese compared with one who does not, for a three-year-old child compared with an adult, and for an individual who is interested in the subject compared with one who is indifferent. This principle, which is so obvious when considered in the context of complex experiences, applies equally to simple ones. Even an apparently simple physical experience (for example, an infant being gently tossed in the air by her father, as babies frequently are) may vary widely depending on the background and state of the individual involved (most adults probably do not like the feeling of being tossed in the air, especially, for example, if it occurs during a particularly turbulent plane ride).

The relative maturity of the brain also has a great impact on experience. Different areas of the brain mature at different rates, with sensory-processing areas maturing earlier than areas supporting complex cognition. A young child who is exposed to information before his or her brain is capable of processing that information will not have the same experience as an adolescent who has more advanced capability. As the brain matures and changes with experience, it is influenced by more complex cognitive interpretations of the environment. Thus, as an individual’s brain changes, particularly during early development, the same physical environment can result in very different experiences. Language acquisition is a good example. We know that the complexity of children’s language, including their vocabulary, depends heavily on the language to which they are exposed. However, using complex sentence structure and “big” words will have much less of an impact on a six-month-old than it will on a three-year-old, owing to different levels of brain maturation at these two ages—the brain of the six-month-old simply cannot make use of this more advanced input.

Finally, certain properties of the brain differ dramatically across individuals and within individuals over time. Therefore, because experience is defined as the interaction of the brain with the environment, a scientific description of an experience must include a description of the context in which experience occurs, the developmental stage of the infant or child, including the maturity of the brain, and a description of the specific experience to which the individual is exposed.

There is a valuable lesson here: infants and children are not passive recipients of information, and experiences do not simply happen to them, no matter how young they are or how passive they may look to adult eyes. Rather, what children bring to the experience matters a great deal. What kinds of things are we talking about, exactly? A short list includes children’s developmental and biological history, their cultural niche, the status and integrity of the brain when the experience occurs, and gradually, how they come to interpret the experience. Two children can grow up under seemingly identical conditions and yet have very different developmental outcomes.

A study of complex reciprocal interactions, such as those described above, requires a longitudinal design and measurement of multiple domains. If properly conducted, it points us to differences in outcomes for young children who begin life in similar conditions of risk. In the case of infants who all were abandoned and lived in contexts of severe psychosocial deprivation, these were our explicit goals in the Bucharest Early Intervention Project (BEIP).

Individuality

The brain develops according to a complex array of genetically programmed influences. These include both molecular and electrical signals that arise spontaneously in growing neural networks. Together these signals establish neural pathways and patterns of connections that are remarkably precise and that make it possible for animals to carry out discrete behaviors beginning immediately after birth. They also underlie instinctive behaviors that may appear much later in life, often associated with emotional responses, foraging, sex, and social behavior.

Genes specify the properties of neurons and neural connections to different degrees in different pathways and at different levels of processing. The extent of genetic determination reflects the degree to which the information processed at a particular connection is predictable from one generation to the next. Because many aspects of an individual’s world are not predictable, the circuitry of the brain relies on experience to customize connections to serve his or her needs. Experience shapes these neural connections and interactions, sometimes powerfully, but always within the constraints imposed by genetics.

The impact of experience on the brain is not constant throughout life. Early experience often exerts a particularly strong influence in shaping the functional properties of the immature brain. Many neural connections pass through a period during development when the capacity for experience-driven modification is greater than it is in adulthood. Language skills, emotional responses, and social behavior, as well as basic sensory and motor capacities, are shaped powerfully and, in many cases, permanently, during these sensitive periods. Thus individual capabilities reflect the combined influences of both evolutionary learning and personal experience.

In the BEIP we have seen domains that are closely tied to sensitive periods (for example, language, attachment) and others less so (executive functions, psychopathology). We have also seen domains in which the efficacy of the intervention is not bounded by time; in other words, development is not constrained by early experience. Thus we are confronted with a dilemma faced by many neuroscientists and psychologists: the interrelationship of dose, timing, duration, and specificity of context; in other words, how much of an experience is critical to facilitate typical development, the timing of that experie...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• Preface
• 1. The Beginning of a Journey
• 2. Study Design and Launch
• 3. The History of Child Institutionalization in Romania
• 4. Ethical Considerations
• 5. Foster Care Intervention
• 6. Developmental Hazards of Institutionalization
• 7. Cognition and Language
• 8. Early Institutionalization and Brain Development
• 9. Growth, Motor, and Cellular Findings
• 10. Socioemotional Development
• 11. Psychopathology
• 12. Putting the Pieces Together
• References
• Notes
• Acknowledgments
• Index