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Physical and neurophysiological maturation associated with ADHD among previously institutionalized children: a
Anne B Arnett1,2, Martín Antúnez3, Charles Zeanah4
1Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.
Insights
Children in institutional care with delayed physical growth show higher rates of attention deficit hyperactivity disorder (ADHD). Foster care placement improved neurophysiology, but slowed growth remained linked to ADHD in institutionalized children.
Area of Science:
- Neuroscience
- Developmental Psychology
- Child Psychiatry
Background:
- Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental outcome in children with a history of early institutional care.
- Previous studies indicated accelerated physical growth as a risk factor for ADHD in institutionalized populations.
Purpose of the Study:
- To investigate physical and neurophysiological growth trajectories in institutionalized children.
- To examine the impact of foster care versus usual care on these trajectories and ADHD outcomes.
- To explore associations between growth patterns, neurophysiology, and ADHD.
Main Methods:
- Longitudinal study of institutionalized children randomized to foster care or usual care, and never-institutionalized controls (Bucharest Early Intervention Project).
- Physical and electroencephalography (EEG) assessments at six time points from infancy to adolescence.
- Multilevel growth and cross-lagged path models to analyze associations between growth, neurophysiology, treatment, and ADHD outcomes.
Main Results:
- Twenty-seven percent of institutionalized children met ADHD criteria.
- Slowed, prolonged growth in height and head circumference correlated with ADHD and delayed foster care placement.
- Foster care placement, not ADHD, predicted peak alpha frequency maturation; ADHD children in foster care had lower theta-beta ratios. No link found between rapid growth and atypical cortical activity.
Conclusions:
- Delayed and prolonged physical growth, alongside atypical neurophysiology from infancy to adolescence, is associated with ADHD in institutionalized children.
- These associations persist despite the protective effects of foster care placement.
Background:
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental outcome among children with a history of early institutional care. Prior research on institutionalized children suggested that accelerated physical growth in childhood is a risk factor for ADHD outcomes.
Methods:
The current study examined physical and neurophysiological growth trajectories among institutionalized children randomized to foster care treatment (n = 59) or care as usual (n = 54), and never institutionalized children (n = 64) enrolled in the Bucharest Early Intervention Project (NCT00747396, clinicaltrials.gov). Participants completed physical and electroencephalography (EEG) assessments at six time points from infancy through adolescence, as well as structured diagnostic interviews at the 54-month and 12-year time points. A series of multilevel growth models and cross-lagged path models were estimated to examine associations among physical and neurophysiological maturation, treatment group, age of foster care placement, and ADHD diagnostic outcomes.
Results:
Twenty-seven percent of the institutionalized children met research criteria for ADHD at one or both time points. Slowed, prolonged growth of height and head circumference were associated with both ADHD and delayed foster care placement. Placement in foster care versus care as usual, but not ADHD, was associated with maturation of the peak alpha frequency. Among children randomized to foster care, average theta-beta ratio was lower among those with ADHD. There was no evidence that rapid physical maturation led to atypical cortical activity.
Conclusions:
Delayed, prolonged physical growth and atypical neurophysiology from infancy through adolescence is associated with ADHD among institutionalized children, over and above the protective effects of foster care.
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