1. Recent studies suggest that living in conditions of neglect and abuse can cause microstructural white matter changes, which may potentially have ramifications on development and behavior.
2. This study lends evidence to the theory that removing children from abusive situations can foster more normative development, possibly through restoration of white matter integrity.
Evidence Rating Level: 2 (Good)
Study Rundown: Exploring the interplay of biologic and environmental factors on development has been a topic of focus for many years. In Bucharest, Romania, where there are a number of children living in institutions due to underdeveloped foster care and adoption programs, this is of particular interest. Specifically, this study sought to investigate whether diffusion tensor imaging (DTI) could detect differences in white matter integrity in children who lived in foster homes, versus those who lived in a child-care institution, versus those who had never lived in an institution. Further the study hypothesized that such white matter changes could underlie behavioral problems associated with children in such social situations. As a secondary topic of investigation the study also followed these children six years later in order to see if these changes could potentially be resolved over time by placement in a foster or adoptive home setting.
The study suggests that early intervention can potentially support reversal of changes in limbic and frontostriatal circuitry and sensory processes. This study involved a randomized design, in which children were placed into foster care or in child care institutions where the ratio of caregivers to children was quite low. A further strength of the study was the attention to multiple DTI variables, including fractional anisotropy, as well as several diffusivity measurements, all of which can describe microstructural white matter abnormalities. Further investigation is merited to study the interaction of these imaging findings with behavior.
In-Depth [randomized controlled trial]: This study was conducted as part of the Bucharest Early Intervention Project (BEIP), which is a randomized trial in which early placement of children in foster homes was compared with ongoing institutionalization. Institutions included 6 different sites across Bucharest Romania, which were similar in terms of high ratio of children to caregivers and limited resources. A network of 56 foster families cared for the 68 children randomized into foster care. Social workers, in consultation with US mental health practitioners, monitored the relationships between children and caregivers and provided guidance. Children were placed into foster care between 5-31 months of age. Diffusion tensor imaging was subsequently obtained from 69 participants between the ages of 8-11 years old, 23 of which were randomized into foster care, 26 of which randomized into institutional care, and 20 children who had never been in institutional care.
Neglect in early life was associated with changes in the fractional anisotropy, and mean radial and axial diffusivity measurements in the DTI. Specifically, microstructural changes in the body of the corpus callosum, limbic circuitry, cingulate cortex, frontostriatal circuitry, and retrolenticular internal capsule were identified. Linear regression models were performed to examine association of the DTI variables with family settings. This follow-up analysis was performed six years after children were placed in these settings. Notably, the foster care group did not significantly differ from the never-institutionalized group in measurements of all tracts except the corpus callosum and superior corona radiata.
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