A prospective study of growth and development of children recently adopted from orphanage care
Margaret F Keil1, Sharon Singh2, Jennifer Graf3, Maddalena Ugolini1, Roma Gandhi1, Patrick Mason4, Penny Glass2 & Constantine A Stratakis1
Author affiliations
1Section on Endocrinology and Genetics, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, Maryland 20892, USA; 2Children’s National Medical Center, Washington, District of Columbia , USA, 3Clinical Center Nutrition Department, NIH, Bethesda, Maryland, USA; 4International Adoption Center, Inova Fairfax Hospital for Children, Fairfax, Virginia, USA.
Background and aims: Over 200 000 international adoptions by US families occurred between 1999–2010. Prior studies suggest that the effects of institutionalized care on growth and development may not be fully reversible. The exact mechanisms through which early life stress affect biobehavioral outcomes have yet to be determined, but environmental influences could regulate both biobehavoral outcomes through an effect on the hypothalamic-pituitary-adrenal (HPA) axis.
Methods: Prospective study of 10 recently adopted children with an average time spent in orphanage care of 23.6±9 months. Eligible participants had no history of significant medical, developmental, or behavioral problems. Anthropometric measurements, HPA axis tests, bone age, neurocognitive testing, and behavioral questionnaires were evaluated.
Results: Shortly after adoption by a U.S. family (1.8±1 mos.), height standard deviation unit (Ht SDU) was −1.6±0.8; weight SDU was (Wt SDU) −0.9±1.2; and head circumference SDU (HC SDU) was −1.8±1 Bone age was consistent with chronological age in four, advanced in three, and delayed in three children. Time in orphanage care was positively associated with serum cortisol (r=0.64; P<0.06) and negatively associated with HT SDU (r=−0.63; P<0.05). Neurocognitive testing (Bayley-III) showed significant delays in all scores. HC SDU was positively associated with cognitive and receptive language subscales on the Bayley III (r=0.62, 0.69; respectively). Response on the Behavior Rating Inventory of Executive Function endorsed clinically significant inhibitory control in half the children, and subscale scores for behavioral regulation were positively associated with HC SDU (r=0.9; P<0.05).
Conclusion: Prenatal factors and time in orphanage care were associated with negative effects on linear growth, serum cortisol, cognitive, and behavioral outcomes.
Clinical implications: Careful assessment of prenatal and environmental risk factors will help to identify children at risk for untoward effects on biobehavioral outcomes and target early interventions.
Comments/keywords: Keywords: Biobehavioral, Cortisol, Growth, Cognitive, Hypothalamic pituitary adrenal axis.