More than 200,000 international adoptions by U.S. families occurred between 1999 and 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 biological and psychosocial development through an effect on the hypothalamic–pituitary–adrenal (HPA) axis. Children were evaluated shortly after adoption for baseline HPA axis function and its association with biobehavioral measures.
This is a prospective study of 10 recently adopted children (19–40 months) 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, physical examination, HPA axis tests, bone age, neurocognitive testing, and behavioral questionnaires were evaluated.
Shortly after adoption by a U.S. family (1.8 ± 1 months), height standard deviation unit (Ht SDU) was −1.6 ± 0.8; weight SDU was −0.9 ± 1.2; and head circumference SDU (HC SDU) was −1.8 ± 1 (WHO growth standards). 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 = .64, p < .06) and negatively associated with Ht SDU (r = −.63, p < .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 = .62 and .69, respectively). Child Behavior Checklist response endorsed one child with attention/withdrawal symptoms. However, 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 = .9, p < .05). HPA axis testing revealed no significant abnormality.
Children adopted from orphanage care experience a negative impact on linear growth, HC, cognitive, and behavioral development. Prenatal factors and time in orphanage care were associated with negative effects on linear growth, serum cortisol, cognitive, and behavioral outcomes.
Careful assessment of prenatal and environmental risk factors will help to identify children at risk for untoward effects on growth, cognitive, and behavioral outcomes and target early interventions.
© 2012 Published by Elsevier Inc.