Significance
UNICEF estimates that there are approximately 8 million children worldwide who live in institutions. Institutional rearing often involves severe psychosocial neglect associated with suboptimal brain and behavioral development. This study uses data from the only existing longitudinal RCT of foster care for institutionally reared children to examine trajectories of memory and executive functioning from childhood to adolescence. We show that institutional rearing is associated with persistent problems in certain functional domains, and developmental stagnancy in others, across this transitional period. There is suggestive evidence that children assigned to early foster care may demonstrate some catch-up over time. Brain activity in childhood is associated with long-term outcomes through age 16, together underscoring the impact of early neglect on children’s neurocognitive development.
Abstract
Children experiencing psychosocial deprivation as a result of early institutional rearing demonstrate many difficulties with memory and executive functioning (EF). To date, there is scant evidence that foster care placement remediates these difficulties during childhood. The current study examined longitudinal trajectories of memory and EF from childhood to adolescence in the Bucharest Early Intervention Project, a randomized controlled trial of foster care for institutionally reared children. We demonstrate that both ever- and never-institutionalized children show age-related improvements on several measures of memory and EF from age 8 to 16. Distinct patterns were observed for different domains of functioning: (i) Early-emerging disparities in attention and short-term visual memory, as well as spatial planning and problem solving, between ever- and never-institutionalized children persisted through adolescence; (ii) the gap in spatial working memory between ever- and never-institutionalized children widened by adolescence; and (iii) early difficulties in visual-spatial memory and new learning among children in foster care were mitigated by adolescence. Secondary analyses showed that higher resting EEG alpha power at age 8 predicted better EF outcomes in several domains at age 8, 12, and 16. These results suggest that early institutional rearing has enduring consequences for the development of memory and EF, with the possibility of catch-up among previously institutionalized children who start out with higher levels of problems. Finally, interindividual differences in brain activity relate to memory and EF across ages, thus highlighting one potential biological pathway through which early neglect impacts long-term cognitive functioning.