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Lecture 10


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Health Studies
Jason Ramsay

Lecture 10: Orphans July 23, 2012 -being an orphan: -there is an orphan crisis in all part of the world, but esp. in developing countries and in countries ravaged by war and diseases -scientists have always been interested in understanding whether orphanage confers adverse effects on long-term health outcomes -understanding these effects allows us to be able to create interventions, and it informs the understanding of childhood development in general -orphans and the critical period hypothesis: -role of critical periods and early environment in biological embedding and development -can the study of orphans provide a means of evaluating the critical period hypothesis? Sir Michael Rutters Group -wanted to investigate the lives of children who were raised in very depriving orphanages -there was a sharp discontinuity between their early and later rearing environment was sudden (they were adopted out to middle class UK families) -they went from extreme high risk to extreme low risk rearing environments -how do children end up with poor long term outcome? -Rutter: Three possibilities: 1) persistence of effect might be brought about by continuities in adversity 2) persistence of the psychological effects of adversity is determined by the individuals cognitive/affective process 3) early adverse experiences bring about a lasting change in the organism in terms of somatic structure and function -continuation of adversity hypothesis: -implies that the adverse outcomes should be largely reversible if there is a sufficiently radical change in environment -later functioning should vary systematically according to differences in the quality of the later environment -cumulative effects should be expected -cognitive-affective hypothesis: -the sequelae should be much less marked if the adverse experience were restricted t an age period when the individual had a limited capacity for processing the events -also, implies that the person much have a kind of amnesia for the events, when they are older -this may sound farfetched, but childhood amnesia is a real phenomenon (happens at 4) -Rutter called this cognitive sets: these sets could play a role in psychological outcomes -lasting changes in the organism hypothesis: -this hypothesis is identical to the biological embedding hypothesis -hypothesizes that there are lasting changes in the physical structure of the organism -the strength of the sequelae should be directly related to the duration of time spent in the poor environment -later function should not vary greatly according to differences in the later environment -this akin to the latent effect hypothesis -experience-adaptive developmental programming -implies that a specific form of development is shaped by the specifics of the environment, such that there is optimal adaptation of the environment -early malnutrition is a good example (remember our previous lecture on the Ductch famine stdies) -later changes in diet/nutrition had little effect on preventing the outcomes -phonological development: children, regardless of language culture, all have the same phonological performance up to a certain age, and then the specifics of their language bias their development (e.g., saying r and l in English) -hypotheses for Rutters ERA Study: 1) the effects seen in Romanian orphans are totally due to subnutrition 2) psychological outcome is determined by the qualities of the environments prevailing at outcome 3) psychological outcome is primarily determined by the cognitive/affectice mental sets that the children develop about their experiences 4) psychological outcome is determined by experience adaptive biological programming 5) psychological outcome is determined by neural damage/experience dependent expectant programming -results of the study -several important areas of development were examined: 1) cognitive development 2) development of attachment 3) head circumference 4) weight -institutional deprivation: -cognitive impairment occurred in 15% of the Romanian adoptees -only 2% cognitive impairment in a group of UK adoptees -there was dose-response curve: -2.3% impairment if experienced 6 months or less in institution -12% if 6-24 months -32.6% if 24-42 months -the same patterns held for attachment behaviours -weight vs. head circumference catch-up -previous research shows that severely malnourished kids show weight catch up once they have had period of good nutrition -in this study, children caught up in weight but NOT in head circumference -head circumference indicative of overall brain size and developmentto a degree -cognitive catch-up: -results clearly showed a dose-response curve -catch was less that complete -again, does response curve: those who were exposed the longest to the conditions of deprivation had the most difficult time catching up in terms of cognitive competency -these deficits were independent of whether or no the child was subnourished -AND no deficits if adopted before 6 months -correlates of cognitive function: -there was a correlation between cognitive impairment/function and duration of institutional care -effect of duration was very strong, even after time in adoptive home was accounted for: deficit in comparison was 20 IQ points -only other major correlate with duration of institutional care was head circumferencewhich also correlated with cognitive function-no effect of biological parents level of education -attachment disinhibition: -patterns of disordered attachment were very common in the adoptees -same dose-response curve -head circumference not related to attachment scores -no effect of subnutrition -lack of relationship between mental age and attachment Bucharest Early Intervention Project (started in 2000) -a randomized, controlled trial of foster care as an intervention for Romanian children -ethical because Romania had no foster care policies at the time -half the children were placed in quality foster care average age at placement was 22 months -a group of never-institutionalized children was also used for comparison -general results: -institutionalized children had lags in the retarded range (70 or less) -attachment was a main area of concern -100% of the attachments in the never-institutionalized children were fully developed -only 3% of the institutionalized children has fully formed attachments -prior to randomization: 65% of institutionalized children had a disorganized attachment -13% had so little attachment behaviour that it could not be evaluated -caregiving quality was significantly higher in the foster care setting -brain activity: -unlike Rutter study, they also used evoked potential brain research tools to evaluate neurocognitive development -neurocognitive results: -smaller amplitudes (neuronal conductivity force) in the institutionalized kids
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