Social and developmental disadvantage

Social deprivation and disadvantage

Isolated and confined children:

  • Feral children- no human contact or nurture

  • Victor of Averyon: discovered in a forest in 1800, believed to have lived in solitude with wolves between the ages of 4 and 12

  • Genie: imprisoned in a dark room and abused from the age of 20 months-13 years

-Physical, cognitive, and social impairments -> limited catch-up as a result of care and education

-Critical periods in language

-Illustrative case studies, but not systematic research

Institutionalized children

  • > 1.5 million children (UNICEF)

  • Quality of care varies across institutions

What resources and experiences might institutionalized children be deprived of?

Risk factors:

  • Low living standards, substandard nutrition

  • High child-to-caregiver ratio

  • Poorly trained caregivers -> insensitive and unresponsive

  • Inadequate cognitive, linguistic, and sensory stimulation

Romanian orphan studies:

• Under Ceausescu’s communist regime, the standard of living was very low, and both contraception and abortions were illegal

• > 100,000 children in institutions

• In 1989, deprivation in orphanages came to light, and many children were adopted in the US, Canada, and Western Europe

‘Natural experiment’: Investigation of consequences of deprivation and critical periods in development

English and Romanian Adoptees Study (ERA)

In a series of longitudinal studies, Rutter and colleagues compared four groups of children

  1. Adopted from Romania before the age of 6 months

  2. Adopted from Romania between 6 and 24 months

  3. Adopted from Romania between 24 and 43 months

  4. Adopted from the UK before 6 months

Romanian group had a lower General Cognitive Index, more attachment problems, inattention/overactivity, emotional difficulties, autistic features, cognitive impairments, peer difficulties, and conduct problems -O’Connor et al. (2000)

• ‘Dose-response’ association between age of arrival and cognitive performance at 4 years and 6 years

• Children arriving before 6 months similar to UK adoptees, 6-24 more affected and over 24 most severely impaired -> this was due to length of deprivation, not length of time in the adopted home

• Children in all groups demonstrated significant catch-up after adoption, but the effect of deprivation still persisted at age 11 for children who spent > 6 months in the institution

BUT: considerable range within groups – the role of resilience O’Connor et al. (2000)

Limitations of the ERA Study:

  • Lack of randomization

  • Potential selection bias

  • Lack of data on individual differences in institutional experiences

  • Lack of adequate comparison groups

Bucharest Early Intervention Project- Zeanah et al. (2006)

Randomized controlled trial of foster care as an alternative to institutional care

  • Children placed in institutions at birth who still live in institutions

  • Children placed in institutions at birth who now live in foster care

  • Children living with their biological families in Bucharest

• Children placed in foster care made significant cognitive, social and emotional gains

• Both children in institutions and children in foster care performed below children raised in their biological families

• For brain activity and attachment, but not psychopathology, children who were placed in foster care before 24 months had better outcomes

The effect of deprivation on brain development

Chugani et al. (2001): PET study

• In comparison with healthy adults and 10-year-olds with refractory epilepsy, Romanian adoptees showed reduced brain metabolism in the PFC, temporal lobe, and regions associated with higher cognitive functions

Parker et al. (2005): ERP study

• In comparison with a non-institutionalized control group, Romanian adoptees showed reduced amplitude in ERP components when presented with facial expressions

Institutionalization reduces cortical brain activity, both metabolically and electrophysiologically

Postnatal brain development is driven by gene x environment interaction -> genes provide early specification of structures and circuits, experience provides specialization and fine-tuning

Experience-expectant features: normal development requires certain experiences during a sensitive phase

• E.g., patterned light information, a responsive caregiver, adequate nutrition

Lack of environmental input -> underspecification/miswiring of circuits

• E.g., Overactive apoptosis

Social disadvantage: the impact of poverty, racial prejudice, and child abuse

On developmental disadvantage and aging:

• Children who grow up socioeconomically disadvantaged face an increased burden of disease and disability throughout their lives

• One hypothesized mechanism for this increased burden is that early-life disadvantage accelerates biological processes of aging, increasing vulnerability to subsequent disease

• Raffington et al. (2021) demonstrate that children growing up under conditions of socioeconomic disadvantage exhibit a faster pace of biological aging

Neighborhood disadvantage

Neighborhood disadvantage is associated with:

• Mental health and wellbeing (Kirby et al., 2020; Visser et al., 2021)

• Externalising behavior (Flouri et al., 2020)

• Cognitive skills (Vinopal & Morrissey, 2020)

• The impact of neighborhood disadvantage on youth outcomes may be stronger for boys (Chetty & Hendren, 2018), perhaps due to time spent outside the home

• Multiple forms of adversity, from distal (e.g., family socioeconomic status [SES]; Farah, 2017; Gianaros & Manuck, 2010) to more proximal and extreme experiences (e.g., harsh parenting, Gard et al., 2017; maltreatment, Hein & Monk, 2017), are associated with variation in brain function

• Gard et al. (2020): Neighborhood disadvantage in early childhood, but not adolescence, was associated with greater amygdala reactivity to neutral faces

Children and social disadvantage

• Low-SES children typically perform worse in school and have worse employment prospects

• Poverty is also associated with behavioural problems, adjustment difficulties, and difficult peer relations

Racial prejudice and discrimination

• 18% of Asian and 20% of African-Caribbean pupils report having been victims of racial abuse

-> Perceived racial discrimination leads to low self-esteem and peer rejection amongst ethnic minority adolescents Verkuyten & Thijs (2001)

• School exclusion affects ethnic minority pupils disproportionately -> Educational gap between white and ethnic minority pupils Wright et al. (2005)

Maltreatment and its consequences

• Sample of almost 70,000 individuals (Humphreys et al., 2020)

• Higher child maltreatment scores were associated with a diagnosis of depression and with higher depression symptom scores

• Although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations

• Danese & Widom (2023) – may be due to the subjective experience of maltreatment – a role for contingent and focused therapy?

• Russotti et al. (2021): Chronicity of maltreatment also predicts outcome

Child maltreatment and psychopathology

• The relationship between child maltreatment and externalizing symptoms (such as conduct disorder) may be mediated by emotion regulation

• Peer rejection is both a consequence and a cause of externalizing symptoms

-Kim & Cichetti (2010)

Child maltreatment -> low emotion regulation -> externalizing symptoms -> peer rejection

Maltreatment and emotion regulation

• Maltreatment is broadly associated with poor emotion regulation as well as increased avoidance, emotional suppression, and expression of negative emotions in response to stress (Gruhne & Compas, 2020)

• Findings highlight stress responses that are likely highly adaptive in maltreating situations

• For example, engaging with the stressor or displaying emotions may be dangerous in high-threat situations (e.g., result in increased abuse), thereby necessitating the use of avoidance and suppression

• Deprivation may prompt emotional expression as an attempt to receive attention from a neglecting caregiver.

• However, the continued use of these strategies after the maltreatment experience has ended likely becomes harmful to normative development (Compas et al., 2017)

Trauma and emotion regulation

• Lower emotion regulation in children with adverse life experiences linked to the HPA system

• In newborns, mildly stressful experiences increase cortisol ->, but the responsiveness of the HPA system decreases gradually

• Sensitive caregiving and attachment security mediate HPA responsiveness

• Deprivation of evolutionarily expected levels of care is associated with dysregulation of the HPA system

• HPA functioning is associated with internalizing and externalizing problems Tarullo & Gunnar (2006)

Emotion recognition and maltreatment

3-5-year-olds’ ability to match facial displays to emotional context was tested

1) Children who experienced neglect

2) Children who experienced physical abuse

3) Non-maltreated children

’Johnny’s friend, who he really likes to play with, moved away. Johnny couldn’t play with his friend anymore.

• Compared with non-maltreated and physically abused children, neglected children showed impaired discrimination of emotional expressions

• Physically abused children displayed a response bias for angry facial expressions whilst neglected children showed a response bias for sad faces

• Neglected children were less able to distinguish between happy and sad expressions than the other groups

Maltreated children’s difficulties with emotion recognition may make it more difficult for these children to effectively recognize and appropriately respond to social signals – this may have an impact on peer relationships. -Pollak et al. (2000)

Protective factors:

• Bronfenbrenner's ecological systems theory

• Family support moderates the effects of displacement and trauma (Caplan et al., 1992)

• ‘Seeking out surrogate parents’ – a positive bond with a caregiver moderates adverse early life experiences (Werner, 1993)

• Community groups moderate the impact of school exclusion (Wright et al., 2005)

Interventions

Large-scale government initiatives

• Sure Start: compensatory education program in areas with high concentrations of 4-year-olds living in poverty

• Aimed at overcoming the cycle of disadvantage faced by poor families

• Improving children’s health, learning, and social-emotional development

• Providing support for parents

• The Head Start Program is a program run by the United States Department of Health and Human Services that provides comprehensive early childhood education, health, nutrition, and parent involvement services to low-income children and their families

• Started in 1965, expanded in 1981, and revised in 2007, it is one of the longest-running programs attempting to address systemic poverty in the United States and has worked with over 25 million children

Lee et al. (2012)

• HeadStart participants tended to have lower scores in all three cognitive outcomes and pro-social behaviors, and higher scores in conduct problems and hyperactivity/inattention, compared to children in other types of care

• Compared to children in pre-K, part-time HS participants had significantly lower scores in early reading, whereas full-time HS participants showed no difference

• Full-time HS participants showed significantly higher scores in early reading (compared to children in other parental care or parental care) and math (compared to children in other non-parental care), while part-time HS participants did not

• However, full-time HS was associated with higher levels of behavioral problems. Fulltime HS participants had more conduct problems compared to children in pre-K or parental care, whereas part-time HS participants showed no differences

PCIT

Parenting interventions that increase parenting skills and improve the quality of the parent-child relationship have been identified as the primary approach for addressing child behavior difficulties in maltreated children

• Relationship-based interventions offer a way to reframe, understand, and respond to behavior that may feel challenging

• One meta-analysis reported that PCIT significantly reduced child externalizing behaviors, improved parenting skills, and decreased parenting stress and child abuse potential in maltreated families (Zhang et al., 2024)