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Randomization into family care rescues grey matter thickness observed as a function of early institutionalization

Fri, March 22, 3:00 to 4:30pm, Baltimore Convention Center, Floor: Level 3, Room 321

Integrative Statement

Introduction. Exposure to psychosocial deprivation is associated with elevations in numerous forms of impairment throughout the life-course. Disruptions in neural structure may be a key mechanism through which this deprivation increases risk for impairment. Existing data consistent with this claim come from correlational studies. Here, we present the first experimental evidence relating psychosocial deprivation and cortical thickness. Using data from the Bucharest Early Intervention Project (BEIP), we investigate the impact of institutionalization on cortical thickness at two longitudinally acquired time points. In previous reports of group differences in cortical thickness when these children were 8 years of age we observed significantly thinner cortices across multiple areas for children with any exposure to institutionalization versus children raised in families since birth. Hypotheses. Considering these previous observations, we hypothesized that ever compared to never institutionalized children would continue to demonstrate cortical thinning across multiple areas of cortex. In addition, we examined differences in cortical thickness and surface area as a function of random placement out of the institution prior to three years of age. Study population. A sample of 136 children living in institutions in Bucharest, Romania and an age-matched sample of 72 community-reared children were recruited to participate. Between 6 and 33 months of age, in a parallel randomization design, half of children in the institutionalized group were randomized to a foster care intervention. The BEIP was initiated at the request of the Secretary of State for Child Protection in Romania and all study procedures were approved by the local commissions on child protection in Bucharest, the Romanian ministry of health, and the institutional review boards (IRBs) of the home institutions of the three principal investigators (CAN, NAF, CHZ). When children were 16 years of age, we acquired MRI data from 115 participants (N = 41 FCG; N=41 CAUG; N=33 NIG; 49% male). Methods. T1-weighted scans were used to calculate cortical thickness and surface area using FreeSurfer. Automatic image segmentation is used to identify sub-cortical gray matter structures. These procedures have demonstrated good test-retest reliability across scanner manufacturers and field strengths, and cortical thickness measures have been validated against manual measurement and histological analysis. Group differences in cortical thickness and surface area were assessed in a whole brain vertex-wise analysis correcting for multiple comparisons using a cluster level correction to p<.05. Results. Across the whole cortex, randomized placement into a family caregiving environment during the infant/toddler period as compared to prolonged institutional care normalized cortical thickness in the anterior cingulate cortex (ACC). This observation is striking as in this study children were placed into foster care in early childhood (before 3 years) but measurement of cortical thickness is during adolescence at 16 years of age. Eight years earlier, these differences in structure of the ACC were observed but were non-significant. This indicates that prolonged exposure to institutional care as compared to family care results in different development of the prefrontal cortex.

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