There’s a heartbreaking photo in the office of Charles A. Nelson, PhD, at Boston Children’s Hospital (BCH). A little girl stands alone in a Romanian orphanage, sucking on a rattle and staring at the camera. “She'd wet her pants and was crying and crying,” Nelson recalls. “No one was paying attention to her. They said, ‘Her mother abandoned her this morning, and she’s been like that all day.’ Their policy was to completely ignore her because that will extinguish the crying.”
Sadly, Nelson has met many forlorn children like this while studying the impact of adverse early experiences—extreme deprivation, neglect, and toxic stress, for example—on brain development. These experiences can hamper a young person’s learning, behavior, and physical and mental health. Nelson, who is research director of the Division of Developmental Medicine at BCH and an HMS professor of pediatrics and psychology, has conducted research from Boston to Brazil to Bangladesh that has illuminated critical periods in neural development when interventions are most needed.
Nelson is the longtime principal investigator for the Bucharest Early Intervention Project, a first-of-its-kind study of Romanian orphans who were randomly assigned to either remain in institutions or be placed in newly created foster homes. Nelson and his colleagues at Harvard, Tulane, and the University of Maryland have followed the project’s 136 children since 2000, monitoring their brain activity with electroencephalogram (EEG) and magnetic resonance imaging (MRI) technology. The National Institute of Mental Health recently extended its funding so participants, many of whom no longer live in orphanages, can be followed through age 21.
Isolation and Neglect
Results from the Bucharest study (and others) underscore the damaging effects of abandonment on children. Nelson explains that the brain’s basic architecture is laid down genetically before birth, and individual experiences after birth shape what happens to our brain circuitry. “The input the brain receives guides its development, and social interaction plays a very, very important role in that,” says Nelson, a developmental cognitive neuroscientist with appointments at several Harvard schools. “That’s what’s missing in these (institutionalized) kids because they’re left alone. They don’t know how to have relationships with anybody.”
In addition to trouble communicating with adults and peers, children who stayed in the Romanian orphanages had reduced brain activity, along with decreased grey and white brain matter, below-normal IQ scores (averaging 66), impaired memory and executive function, and high rates of behavioral and emotional problems. On the other hand, the study shows that some of these harmful effects can be reversed, or at least lessened, if children are removed from stifling environments by roughly age 2. For example, electrical activity in the brain, an indicator of how well neurons are communicating, drops in kids raised in institutions—much like turning down the dimmer switch on a light. Placing those orphans in foster care before age 2 appears to turn up the dimmer, “and it looks like they have about as much brain activity as kids who’ve never been in an institution,” according to Nelson. “And that effect persists all the way through age 16.”
The door to recovery doesn’t shut at 2, but the longer one waits to improve a child’s surroundings, the harder it is to get them back on track, he notes.
Nelson suggests these Romanian findings offer lessons for other situations closer to home, such as policies that put young prisoners in solitary confinement or separate children from their immigrant parents at the U.S.-Mexico border.
At least 2.7 million children and teens are living in “residential care” (institutions) worldwide—and that figure is probably much higher, according to UNICEF. Some are orphaned by disease, war, or natural disasters, but others are simply abandoned by their parents “and have suffered greatly for no good reason,” Nelson says. He notes that neglect is the most common form of child maltreatment in the U.S.
“The success of our societies rests on the healthy development of its children,” Nelson and co-authors conclude in a 2019 article in Neural Plasticity about the consequences of early psychosocial deprivation. “Steps can and should be taken to ensure all children have the opportunity to live up to their developmental potential.”
Debra Bradley Ruder is a freelance medical writer based in Greater Boston.