Ethical considerations in international research collaboration: The Bucharest early intervention project

Zeanah, Charles H.; Koga, Sebastian F.; Simion, Bogdan; Stanescu, Alin; Tabacaru, Cristian L; Fox, Nathan A.; Nelson, Charles A.

doi:10.1002/imhj.20107

Cited by 50 publications

(40 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, the institutional review boards of the institutions of the three principal investigators reviewed and approved the study. A detailed accounting of efforts to ensure ethical integrity has been published (62)(63)(64).…”

Section: Methodsmentioning

confidence: 99%

Causal effects of the early caregiving environment on development of stress response systems in children

McLaughlin

Sheridan

Tibu³

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

Self Cite

381

330

View full text Add to dashboard Cite

Disruptions in stress response system functioning are thought to be a central mechanism by which exposure to adverse early-life environments influences human development. Although early-life adversity results in hyperreactivity of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis in rodents, evidence from human studies is inconsistent. We present results from the Bucharest Early Intervention Project examining whether randomized placement into a family caregiving environment alters development of the autonomic nervous system and HPA axis in children exposed to early-life deprivation associated with institutional rearing. Electrocardiogram, impedance cardiograph, and neuroendocrine data were collected during laboratorybased challenge tasks from children (mean age = 12.9 y) raised in deprived institutional settings in Romania randomized to a highquality foster care intervention (n = 48) or to remain in care as usual (n = 43) and a sample of typically developing Romanian children (n = 47). Children who remained in institutional care exhibited significantly blunted SNS and HPA axis responses to psychosocial stress compared with children randomized to foster care, whose stress responses approximated those of typically developing children. Intervention effects were evident for cortisol and parasympathetic nervous system reactivity only among children placed in foster care before age 24 and 18 months, respectively, providing experimental evidence of a sensitive period in humans during which the environment is particularly likely to alter stress response system development. We provide evidence for a causal link between the early caregiving environment and stress response system reactivity in humans with effects that differ markedly from those observed in rodent models.childhood adversity | early-life stress | HPA axis | autonomic nervous system | stress reactivity D isruptions in stress response system functioning are thought to be a central mechanism by which exposure to adverse early-life environments influences human development. This idea is borne out in rodent models, where the effects of early-life adversity on the development of stress response systems have been well characterized. Exposure to early-life adversityinvolving repeated and prolonged separation of a pup from its mother-results in hyperreactivity of the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis in adolescence and adulthood and elevations in anxiety, fearful behaviors, and hypervigilance (1-4). Stress exposure in mature rodents is associated with immediate, but not lasting, changes in stress response systems (5, 6), suggesting the presence of an early sensitive period when exposure to adverse environments results in long-term changes in physiological stress response system functioning.

show abstract

Section: Methodsmentioning

confidence: 99%

Causal effects of the early caregiving environment on development of stress response systems in children

McLaughlin

Sheridan

Tibu³

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

Self Cite

381

330

View full text Add to dashboard Cite

show abstract

“…All study procedures were approved by the local commissions on child protection in Bucharest, the Romanian ministry of health, and the institutional review boards of the home institutions of the three principal investigators. A more complete description of procedures used to ensure ethical integrity has been published previously and commented on by the scientific community (40,41). Information about the randomization procedures and foster care intervention can be found in SI Materials and Methods.…”

Section: Methodsmentioning

confidence: 99%

Variation in neural development as a result of exposure to institutionalization early in childhood

Sheridan

Fox

Zeanah

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

Self Cite

381

293

View full text Add to dashboard Cite

We used structural MRI and EEG to examine brain structure and function in typically developing children in Romania (n = 20), children exposed to institutional rearing (n = 29), and children previously exposed to institutional rearing but then randomized to a high-quality foster care intervention (n = 25). In so doing, we provide a unique evaluation of whether placement in an improved environment mitigates the effects of institutional rearing on neural structure, using data from the only existing randomized controlled trial of foster care for institutionalized children. Children enrolled in the Bucharest Early Intervention Project underwent a T1-weighted MRI protocol. Children with histories of institutional rearing had significantly smaller cortical gray matter volume than never-institutionalized children. Cortical white matter was no different for children placed in foster care than never-institutionalized children but was significantly smaller for children not randomized to foster care. We were also able to explain previously reported reductions in EEG α-power among institutionally reared children compared with children raised in families using these MRI data. As hypothesized, the association between institutionalization and EEG α-power was partially mediated by cortical white matter volume for children not randomized to foster care. The increase in white matter among children randomized to an improved rearing environment relative to children who remained in institutional care suggests the potential for developmental "catch up" in white matter growth, even following extreme environmental deprivation.neglect | brain development | early adversity | brain volume | early experience A common societal response to orphaned or abandoned children is to rear such children in institutions (1, 2). UNICEF estimates that there are at least 8 million children who live in institutional settings. Institutional rearing of young children represents a severe form of early psychological and physical neglect, and as such, serves as a model system for understanding how early experience-or the lack of thereof-impacts brain and behavioral development.In most forms of institutional rearing, the ratio of caregiversto-children is low (e.g., in our sample ∼1:12), care is highly regimented, and caregiver investment in children is low (3). Children raised in institutions are more likely than children raised in families to have deficits in cognitive function (4, 5) and in language production and comprehension (6, 7). Relative to noninstitutionalized children, children reared in institutional settings experience a wide range of developmental problems including markedly elevated rates of attention-deficit/hyperactivity disorder and other forms of psychopathology (8-10) and difficulties with social functioning (11-13). These developmental difficulties are not unique among children exposed to institutionalization. Indeed, exposure to a wide range of adverse early environments-including physical and sexual abuse, neglect, domestic violence, and c...

show abstract

“…Assent for each procedure was obtained from each of the children. Additional safeguards, protections, and considerations related to conducting research with this specific sample of children have been discussed previously (Wassenaar, 2006, Zeanah et al, 2006, Millum and Emanuel, 2007, Nelson et al, 2007). …”

Section: Methodsmentioning

confidence: 99%

Early deprivation, atypical brain development, and internalizing symptoms in late childhood

et al. 2017

View full text Add to dashboard Cite

Children exposed to extreme early life neglect such as in institutional rearing are at heightened risk for developing depression and anxiety disorders, and internalizing problems more broadly. These outcomes are believed to be due to alterations in the development of neural circuitry that supports emotion regulation. The specific neurodevelopmental changes that contribute to these difficulties are largely unknown. This study examined whether microstructural alterations in white matter pathways predicted long term risk for internalizing problems in institutionally reared children. Data from 69 children were drawn from the Bucharest Early Intervention Project, a randomized clinical trial of foster care for institutionally reared children. White matter was assessed using Diffusion Tensor Imaging (DTI) when children were between 8 and 10 years of age. Internalizing symptoms were assessed at the time of the MRI scan, and once children reached 12 to 14 years of age. Results indicated that neglect-associated alterations in the external capsule and corpus callosum partially explained links between institutional rearing status and internalizing symptoms in middle childhood and early adolescence. Findings shed light on neural mechanisms contributing to increased risk for emotional difficulties among children reared in adverse conditions and have implications for prevention and intervention.

show abstract

Ethical considerations in international research collaboration: The Bucharest early intervention project

Cited by 50 publications

References 21 publications

Causal effects of the early caregiving environment on development of stress response systems in children

Causal effects of the early caregiving environment on development of stress response systems in children

Variation in neural development as a result of exposure to institutionalization early in childhood

Early deprivation, atypical brain development, and internalizing symptoms in late childhood

Contact Info

Product

Resources

About