The Lasting Effects of Neglect: Altered Brain Structure in Children

Fortunately, good foster care can help neglected children catch up developmentally, in part.

Kids who are neglected, growing up without normal emotional and social interaction, have measurably different brain structure from other kids, according to a new study from researchers at Boston Children’s Hospital.

The study compares kids raised in Romania’s infamous state-run orphanages with kids raised in normal Romanian family homes at the same time. MRI brain scans show that children raised in run-down institutions — typically with just one adult supervisor per 12 young kids — developed measurably lower grey matter volume and white matter volume in the cortex of the brain than children who grew up among their families.

However, children who spent their infancy in the orphanages but were then delivered to high-quality foster care as small children fared somewhat better than those left behind in the institutions. Those kids’ cortical white matter was no different from that among children who had always lived with families, the study shows. But the foster kids still had lower grey matter volume than normal. The findings do show “the potential for developmental ‘catch-up’ in white matter growth, even following extreme environmental deprivation,” the study authors write. And that’s cause for optimism: it shows that some of the damage due to early childhood neglect can be undone.

White matter is important because it’s responsible for much of the connectivity between different regions of the brain; it’s the brain’s “information superhighway,” as one of the researchers puts it. But growth of grey matter — the part of the brain thought to control sensory perception and muscle control — tends to happen during concentrated periods of childhood, not all throughout childhood like white matter growth does. This may be why grey matter development seems harder to catch up on later, the authors write in their paper.

These latest findings about the long-term consequences of neglect are only the latest from a prolific research program known as the Bucharest Early Intervention Project. Under the authoritarian rule of Nicolae Ceausescu, starting in the late 1960s, Romania enacted laws to encourage women to have at least five children. Contraception and abortion were outlawed, so that sick and unwanted babies were abandoned in large, understaffed institutions.

The results were horrific. Kids went without adequate beds, clothes, bathroom facilities or adult supervision. By the end of the Ceausescu regime, in the last days of 1989, there were more than 100,000 children living in the institutions. BEIP began a full decade later, in 2000, to assess the consequences of early childhood deprivation and to test the efficacy of new foster-care programs. The Project is run out of Boston Children’s Hospital’s Labs of Cognitive Neuroscience.

For their research, the Boston scientists recruited 136 young children who were institutionalized in 2001 in Bucharest, Romania. They randomized half the kids to enter high-quality foster care and half to stay in institutional care — which had been improved substantially since the Ceausescu era, although staff-to-children ratios remained high. Through the years since BEIP has started, its researchers have shown that neglected kids fall short on IQ and language skills; that they are more prone to behavior disorders and repetitive motions like rocking, flapping and banging their heads against things; and that they even show signs of accelerated cell aging.

The latest results about brain structure, published online this week in the Proceedings of the National Academy of Sciences, are based on screenings conducted when the kids in the study were aged 8 to 11. These new findings seem consistent with previous BEIP research on cognitive development among institutionalized kids. “These differences in brain structure appear to account for previously observed, but unexplained, differences in brain function,” lead researcher Margaret Sheridan told reporters.

And the importance of the findings remains grave. At least 8 million children worldwide currently live in institutions, according to UNICEF. Many of those kids continue to experience severe social or physical neglect.

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