Charles Zeanah
Tulane University, Psychiatry, Faculty Member
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Objective: Early psychosocial deprivation increases the risk of later cognitive and psychiatric problems, but not all deprived children show these difficulties. Here, we examine the extent to which psychosocial deprivation increases the... more
Objective: Early psychosocial deprivation increases the risk of later cognitive and psychiatric problems, but not all deprived children show these difficulties. Here, we examine the extent to which psychosocial deprivation increases the risk of later cognitive and psychiatric difficulties and the downstream consequences of this for risk-taking behavior in adolescence.Method: Children abandoned to institutions early in life were randomly assigned to care-as-usual or a foster care intervention during infancy. A separate group of never-institutionalized children was recruited as a comparison sample. The current follow-up study included 165 children (51% female), 113 with a history of institutionalization and 52 with no such history. At age 12, caregivers reported on children's psychiatric difficulties, and their IQ was assessed by standardized testing. At 16 years, risk-taking behavior was assessed from youth self-reports.Results: Latent profile analysis revealed three subgroups of children with varying levels of cognitive and psychiatric difficulties: Low-Morbidity (n = 104, 62.7%), Medium-Morbidity (n = 46, 27.9%), and High-Morbidity (n = 15, 9.4%). Nearly half of the institutionalized children belonged to the High- or Medium-Morbidity subgroups; and institutionally-reared children were significantly more likely to belong to one of these profiles than never-institutionalized children. Compared to the Low-Morbidity subgroup, membership in the Medium-Morbidity profile was associated with higher levels of risk-taking behavior at age 16 years.Conclusions: Children who experience psychosocial deprivation are considerably more likely to present with elevated cognitive and psychiatric difficulties in early adolescence and, for some children, this elevation is linked to heightened risk-taking behavior in later adolescence.
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In this paper, we consider whether the field of infant and early childhood mental health (IECMH) needs its own code of ethics. We begin by describing unique features of infant and early childhood mental health (IECMH) and the diverse... more
In this paper, we consider whether the field of infant and early childhood mental health (IECMH) needs its own code of ethics. We begin by describing unique features of infant and early childhood mental health (IECMH) and the diverse strategies that the field has developed to address complex clinical dilemmas, among them workforce development, clinical supports, policy statements, and statements of ethical values. Because of the field's interdisciplinary nature, we also consider how various contributing professions and organizations address ethical issues. While these are important resources that can inform ethical decision‐making, we identify some of the limitations of the current approaches. We argue that it is time for the field of IECMH to take an intentional, systematic approach to directly address the complex and unique ethical dilemmas faced by infant and early childhood mental health practitioners, and we grapple with some of the challenges developing such a code might e...
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ResumenIntroducción a la Sección Especial: Hacer lo ‘correcto:’ Asuntos éticos en la salud mental infantil y en la temprana niñezética, salud mental infantil y en la temprana niñez, código de ética
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Infant mental health is explicitly relational and strengths based as a field. Ethical dilemmas in infant mental health have received insufficient attention at the level of infant mental health professionals (IMHP) and other professionals... more
Infant mental health is explicitly relational and strengths based as a field. Ethical dilemmas in infant mental health have received insufficient attention at the level of infant mental health professionals (IMHP) and other professionals caring for infants who must grapple with questions of when caregivers and infants have conflicting interests. We present composite cases drawn from North American and Australian contexts, using three systems in which such conflicts may commonly manifest: child protection, home visiting, and medical settings. The field of infant and early childhood mental health (IECMH) should begin to discuss such dilemmas and how best to balance the needs of caregivers and infants when they are not well aligned.
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Ethics is concerned with the basis for moral judgments of “right” and “wrong” and is central to the clinical endeavor. Many clinicians integrate ethical estimations into their work without much conscious awareness. However, explicit use... more
Ethics is concerned with the basis for moral judgments of “right” and “wrong” and is central to the clinical endeavor. Many clinicians integrate ethical estimations into their work without much conscious awareness. However, explicit use of ethical principles and frameworks can help navigate clinical decision‐making when there is a sense of moral conflict or ambiguity about the “right” course of action. This article aims to highlight the key concepts and principles in clinical ethics as they apply to IECMH practice and stimulate a bigger conversation in the profession around how to support each other to maintain high ethical standards in working with young children and their families. Specifically, the authors consider the relevance of Beauchamp and Childress’ four principles framework (respect for autonomy, beneficence, non‐maleficence, and justice), and address some of the special ethical challenges in the field, namely, the vulnerability of the infant, the need for a competent wor...
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Autonomic nervous system reactivity has been posited to be a mechanism contributing to social and emotional problems among children exposed to early adversity. Leveraging data from the Bucharest Early Intervention Project, a longitudinal... more
Autonomic nervous system reactivity has been posited to be a mechanism contributing to social and emotional problems among children exposed to early adversity. Leveraging data from the Bucharest Early Intervention Project, a longitudinal randomized controlled trial of foster care versus institutional care of abandoned children in Romania, we assessed whether altered sympathetic reactivity to peer rejection feedback in early adolescence mediated the relation between early institutional rearing and peer problems in later adolescence. We also assessed whether adolescent friendship quality or randomized placement in foster care early in life moderated these associations. Participants include 68 institutionalized children randomized to care as usual, 68 institutionalized children randomized to foster care, and 135 never-institutionalized children. At age 12, participants reported friendship quality with respect to a best friend and completed a social rejection task while electrocardiogram and impedance cardiography were recorded. Sympathetic nervous system reactivity to rejection feedback was assessed using preejection period (PEP). At ages 12 and 16, peer problems were reported by parents. Mediation analysis revealed that less PEP reactivity to social rejection at age 12 partially mediated the association between early institutionalization and greater peer problems at age 16. Further moderated mediation analysis revealed that this indirect effect was evidenced among previously institutionalized youths with low, but not high, quality friendships. We did not observe foster care intervention effects. These findings suggest that altered sympathetic reactivity to social rejection might be a mechanism linking early institutionalization to social difficulties into adolescence, however, positive adolescent friendships may buffer these effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Research Interests: Psychology, Psychometrics, Forecasting, Medicine, Humans, and 15 morePosttraumatic stress disorder, Female, Predictive Validity, Male, Infant, Follow-up studies, Arousal, Preschool Children, Reproducibility of Results, Predictive value of tests, Infant Behavior, Child preschool, Child behavior disorders, Psychology and Cognitive Sciences, and Medical and Health Sciences
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The Bucharest Early Intervention Project (BEIP) is the only randomized controlled trial of foster care for children who were abandoned at or shortly after birth and placed into institutional care. The study conducted careful... more
The Bucharest Early Intervention Project (BEIP) is the only randomized controlled trial of foster care for children who were abandoned at or shortly after birth and placed into institutional care. The study conducted careful pre-randomization assessments at a mean age of 22 months and has included follow-ups through mid-adolescence. This longitudinal study has provided important insight into the effects of psychosocial deprivation on brain and behavioral development, the importance of sensitive periods, and the ability to recover from severe neglect through high-quality and stable caregiving environments. This chapter reviews the impetus behind the BEIP, as well as key findings related to psychopathology across the longitudinal study. Specifically, early deprivation history is associated with increased risk for psychopathology. In attachment disorder symptomatology, as well as internalizing, externalizing, and attention-deficit/hyperactivity disorder (ADHD) domains, those who had ever experienced institutional care had higher levels of symptoms and/or greater likelihood of meeting diagnostic criteria at the disorder level. Importantly, however, children assigned to the foster care intervention had more positive outcomes in all domains, with the exception of ADHD, in which there was no treatment effect. Secondary analyses indicated important mediators (e.g., attachment security; neural functioning) and moderators (e.g., age of placement; placement stability) of the interventions effect on psychopathology.
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Research Interests: Psychology, Medicine, Molecular Psychiatry, Biological Sciences, Molecular, and 14 moreHumans, Child, Female, Male, Infant, TELOMERE SHORTENING, Time Factors, Telomere, Psychosocial deprivation, Randomized Controlled Trials as Topic, Child preschool, Sex Characteristics, Psychology and Cognitive Sciences, and Medical and Health Sciences
We examined whether family care following early‐life deprivation buffered the association between stressful life events (SLEs) and executive functioning (EF) in adolescence. In early childhood, 136 institutionally reared children were... more
We examined whether family care following early‐life deprivation buffered the association between stressful life events (SLEs) and executive functioning (EF) in adolescence. In early childhood, 136 institutionally reared children were randomly assigned to foster care or care‐as‐usual; 72 never‐institutionalized children served as a comparison group. At age 16 years, adolescents (n = 143; 54% female; 67.1% Romanian) self‐reported recent SLEs, completed a battery of memory and EF tasks, and completed a go/nogo task in which mediofrontal theta power (MFTP) was measured using electroencephalogram. More independent SLEs predicted lower EF and more dependent SLEs predicted lower MFTP, but only among adolescents with prolonged early deprivation. Findings provide preliminary evidence that family care following early deprivation may facilitate resilience against stress during adolescence on EF.
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ZERO TO THREE • JANUARY 2017 ZERO TO THREE published DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood in December 2016. This article is a brief guide to DC:0–5, designed both... more
ZERO TO THREE • JANUARY 2017 ZERO TO THREE published DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood in December 2016. This article is a brief guide to DC:0–5, designed both for readers who are familiar with DC:0–3R and the original DC:0–3 and those for whom DC:0–5 is their introduction to this diagnostic classification system. The authors are members of the Diagnostic Classification Revision Task Force who completed the update and revision. Abstract This article introduces the revised and updated DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. The authors describe the past and current efforts to create a developmentally based classification system for very young children. DC:0–3, published in 1994 by ZERO TO THREE, was created to address the significant need for a systematic, developmentally based approach to the classification of mental health and develo...
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The JCPP works at the cutting edge of clinical science to publish ground-breaking research across the full range of topics in the field of child psychology and psychiatry. As JCPP editors, who are also active researchers in our own right,... more
The JCPP works at the cutting edge of clinical science to publish ground-breaking research across the full range of topics in the field of child psychology and psychiatry. As JCPP editors, who are also active researchers in our own right, we are conscious of the threat posed to our field by what has come to be known as the reproducibility crisis - the fact that many published findings, initially trumpeted as important developments in the field, cannot be replicated and are therefore likely to be spurious (Nature Human Behaviour, 1, 2017, 21). The JCPP is conscious of its responsibility to play its part in addressing this issue as best it can. The roots of the problem are complex and its causes multifaceted. As one part of its response, the JCPP embraces the principles of open science and encourage preregistration of study protocols. Furthermore, we are working towards implementing new systems to promote preregistration with the hope of increasing scientific transparency and accounta...
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ABSTRACT
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... Citation. Database: PsycINFO. [Chapter]. Contributions of attachment theory to infant-parent psychotherapy and other interventions with infants and young children. ... The third section describes other programs and approaches... more
... Citation. Database: PsycINFO. [Chapter]. Contributions of attachment theory to infant-parent psychotherapy and other interventions with infants and young children. ... The third section describes other programs and approaches influenced by attachment theory. ...
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ABSTRACT The clinical science of psychiatry rests upon the basic science of developmental psychology, which is increasingly enriched by neurobiology, genetics, ethology, linguistics, and many other disciplines. In this chapter, we... more
ABSTRACT The clinical science of psychiatry rests upon the basic science of developmental psychology, which is increasingly enriched by neurobiology, genetics, ethology, linguistics, and many other disciplines. In this chapter, we consider how findings from these fields may usefully inform our understanding of how development proceeds in the first 3 years of life. We consider multiple lines of development and the major periods of reorganization they undergo as the child moves from a relatively helpless newborn infant to a semi-autonomous 3-year-old capable of coming and going as he pleases, imaging reality different from his experience, communicating abstractly using symbols and decoding and responding to subtle social cues.
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ABSTRACTThe Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0–5; ZERO TO THREE) is scheduled to be published in 2016. The articles in this section are selective... more
ABSTRACTThe Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0–5; ZERO TO THREE) is scheduled to be published in 2016. The articles in this section are selective reviews that have been undertaken as part of the process of refining and updating the nosology. They provide the rationales for new disorders, for disorders that had not been included previously in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0–3R; ZERO TO THREE, 2005), and for changes in how certain types of disorders are conceptualized.