Externalizing trajectories predict elevated inflammation among adolescents exposed to early institutional rearing

• In Event: 1-037 - Developmental Influences on Cardiometabolic Risk in the Early Lifespan

Integrative Statement

Children with a history of institutional rearing are at increased risk for various types of psychopathology (Humphreys et al., 2015a; 2015b; 2017). Adverse childhood experiences (e.g., child maltreatment) combined with depression have been related to elevated inflammation in adolescence (Danese et al, 2011; Miller & Cole, 2012) and adulthood (Danese et al., 2008). However, associations between psychopathology and inflammation have not been examined following severe psychosocial deprivation. This study uses data from a longitudinal randomized control trial of foster care as an alternative to institutional care, the Bucharest Early Intervention Project. We examined trajectories of externalizing behaviors, including ADHD behaviors, across childhood and adolescence and their relation to C-reactive protein (CRP). CRP is a reliable indicator of systemic inflammation and risk factor for cardiovascular disease (Ridker et al., 2000). We predicted that high and stable patterns of externalizing behaviors would be associated with elevated CRP among adolescents with a history of institutional rearing.

We followed children who as infants had varying amounts of institutional rearing, before being randomized to care as usual (CAUG; n=68) or to foster care intervention (FCG; n= 68) at approximately 20 months of age, and a never institutionalized group (NIG; n=72) from Bucharest, Romania. Participants’ externalizing behaviors were reported by teachers at age 8 and by teachers and parents at ages 12 and 16 using the MacArthur Health and Behavior Questionnaire (Essex et al., 2002). At age 16, a subset of participants (n=127) provided dried blood spots, from which CRP was derived. Externalizing trajectories and their association with CRP were examined using multiple-group latent growth curve models, with CRP regressed on the intercept and slope, controlling for body mass index. Group contrasts for the intercept, slope, and path coefficients were conducted using χ2 difference tests.

All models demonstrated good fit, CFI > .95, RMSEA < .05, SRMR <.08. As seen in Figure 1 and Table 1a, the CAUG and FCG showed higher levels of externalizing behaviors at age 8 that decreased from age 8 to 16 years, whereas the NIG showed relatively lower initial levels that remained stable. Within the CAUG, both externalizing behaviors at age 8 and less decrease in these behaviors from 8 to 16 years predicted higher levels of CRP at age 16 (Table 1b). In contrast, these relations were not observed in the FCG or NIG. Furthermore, the path coefficient linking the relation from the slope of externalizing behaviors to CRP was different between the CAUG and NIG, χ2diff(1)=9.18, p=.002, but not between the CAUG and FCG. Additional analyses performed for each sex separately showed similar results, with the intercept and slope predicting higher CRP in CAUG girls, and the intercept predicting higher CRP in CAUG boys.

High-stable externalizing problems across childhood and adolescence was related to elevated inflammation in late adolescence among children exposed to early institutional rearing. In contrast, early placement into foster care buffered against risk for externalizing problems and inflammation. We will discuss these findings in the context of the neuro-immune network hypothesis.

Authors

• Alva Tang, University of Maryland, College Park
  Presenting Author

• Natalie Slopen, 2School of Public Health, University of Maryland, College Park
  Non-Presenting Author

• Charles A. Nelson, Harvard Medical School
  Non-Presenting Author

• Charles Zeanah, Tulane University
  Non-Presenting Author

• Nathan Fox, University of Maryland
  Non-Presenting Author