Paper

The following is a paper I wrote for my developmental psych class, in response to a study we read in the course:

The goal of the Tottenham et al. study was to track the volumes of the amygdala and hippocampus in relation to length of exposure to institutional child-rearing and the presence of internalizing behaviors and anxiety. Researchers measured the brain structures using magnetic resonating imaging (MRI) and the behaviors with a structured interview and two behavioral questionnaires. The researchers hypothesized that larger amygdala volume in previously institutionalized children is associated with longer time spent in the institution (thus longer exposure to early-life stress), and in turn that larger amygdala volume is positively correlated to anxiety and internalizing behaviors (Tottenham et al., 2009).

Previous human studies show that previously institutionalized children have higher rates of anxiety disorders, and that adults that have anxiety also have larger amygdalae, while adults who have undergone major stress or trauma also have lower hippocampal volume. However, studies of children in relation to hippocampal size and stress do not show this result, which may suggest hippocampal recovery after early-life stress (Tottemham et al., 2009). These previous studies were used in to predict that amygdala volume would have a higher correlation with anxiety and internalizing behaviors than the hippocampus.

This study also measures length of exposure time in child-rearing institutions based on the research by Nelson et al. on rhesus monkeys, which showed that timing of the separation of infant and mother monkey influences emotional behavioral problems (Tottenham et al., 2009). Timing could have a similar effect contributing to the behavioral difficulties of previously institutionalized children.

The subjects totaled seventy-eight children, thirty-eight of whom had been previously institutionalized. A slight majority of those previously institutionalized children showed signs of psychiatric disorders from the outset of the study, including eighteen percent who qualified as having an anxiety disorder. The previously institutionalized group and non-institutionalized group were comparable in socioeconomic status. The study measured for age at adoption, with older adopted children having more time spent raised in institutions and less time with the family, whereas younger adopted children had less time in institutions and thus more time with the family. Early adopted children were defined as younger than fifteen months old, and late adopted children were defined as older than fifteen months old (Tottenham et al., 2009).

Based on these ages, the groups were further divided into four final groups: early-adopted, late-adopted, and two control groups consisting of non-institutionalized children. Both neuroimaging and behavioral assessments were conducted on these four groups, which consisted of structural MRI, structured interviews, and internalizing and anxiety questionnaires such as the Child Behavior Checklist (CBCL) and Screen for Child Anxiety Related Emotional Disorders (SCARED), which were completed by the parents and controlled for with the Wechsler Abbreviated Scale of Intelligence IQ test. . The MRI provided volumetric data on the specific brain structures of interest, the amygdala, the hippocampus, and the caudate, which was measured for control. The questionnaires provided additional data relating to internalizing and anxiety disorders that were used for comparison to the sizes of these brain structures (Tottenham et al., 2009).

The study’s findings from the MRI data showed that late-adopted children had significantly larger amygdala volumes than the early-adopted group and both control groups. Researchers also found that a positive correlation exists between amygdala volume and age at adoption. Hippocampal volume was not significantly different, unlike the previous animal studies that showed smaller hippocampal volume after stress (Tottenham et al., 2009). The study’s findings from the behavioral data showed that larger amygdala volume also positively correlated with scores from the CBCL and SCARED tests, which indicates that larger amygdalae were present in children whose parents rated higher levels of internalizing and anxiety-related behaviors (Tottenham et al., 2009). These data also support the hypothesis.

These data suggest that early-life stress (in this case resulting from institutionalized child care) can result in a highly developed amygdala, which in turn correlates to an increased prevalence of internalizing behaviors and anxiety. Disturbances in attachment, the process of bonding to a primary caregiver, may explain these findings. Institutional child-rearing settings do not often allow for the deep one-on-one connection between caregiver and child that results in attachment. For example, some institutions have a ratio of twenty children to one caregiver, which can lead to unstable relationships (Tottenham et al., 2009). According to studies, children who are attached to a caregiver are more confident and mature, while non-attached children show greater risk for emotional and interpersonal difficulties (Belsky, 2010). This information is consistent with the study’s findings, in that both attachment disturbances and larger amygdala volume correlate with these internalizing behaviors (fear, social inhibition, and depression) and anxiety (Belsky, 2010). Attachment disturbances related to the stressful reality of institutional care may play a role in the larger amygdala volume results in this study.

The amygdala serves the function of recognizing emotional cues and aids emotional expression. It is a part of the limbic system, which as a whole processes emotional reactions, such as anxiety (Hansell & Damour, 2008). An imbalance in development of these brain structures in relation to the frontal lobe may produce confused social responses, according to a study by Yurgelin-Todd and Killgore (2006), which focused on the differences between adolescent and adult brains. Adolescents more often misinterpreted fearful facial expressions, which may be explained by their tendency to engage the amygdala versus the frontal cortex, like adults did. A larger amygdala volume may contribute to internalizing behaviors and anxiety because of these confused social responses. In addition, larger amygdalae are present and more often engaged in anxiety-prone children (Tottenham et al., 2009). This evidence in combination with the results of the study and prior attachment research supports the study’s hypothesis that a relationship exists between early life stress, amygdala volume, internalizing behaviors and anxiety.

A major limitation of this study is the lack of randomization in the sample. Adopted children in this case were not randomly assigned to their new families, which could affect the levels of internalizing behaviors and anxiety noted in the children. A child may have experienced a disproportional amount of stress in comparison to the other children based on other factors, such as culture shock. Alternatively, another child may have an exceptionally smooth transition into his or her new home due to more compatible cultural backgrounds. Both of these factors are possible without being influenced by amount of time spent in the institution.

Another limitation present in the study comes from its correlational design. While a relationship is evident between increased amygdala volume, behavioral issues, and longer time spent in the institution, this pattern may have another explanation. Behavioral problems may already exist in potentially adopted children, and may have a role in discouraging adoptive parents from selecting that child instead of another child who appears more psychologically fit. Instead of the length of time in the institution predicting these behavioral problems and larger amygdala volume, these behavioral issues may be the reason for the longer stay in the institution and the resulting amygdala growth.

Follow-up research for this study could involve a longitudinal study testing whether an intervention technique for newly adopted children could benefit these children in relationship to the development of amygdala volume and behavioral problems. Study participants would include a group of previously institutionalized children who were adopted after fifteen months of age and a control group of children who were never institutionalized. The study would measure for any amygdala recovery and behavioral problems over time, with the previously institutionalized children divided into two randomized groups: those who receive the intervention and those who do not. The control groups would be similarly divided. The intervention would entail a specific training program for parents designed to minimize potential culture shock and strengthen parent-child bonding early in the process. The use of MRI, CBCL and SCARED tests could be used in the same fashion as the current study. This follow-up study would be important to see if interventions of this type could be used to lessen the prevalence of internalizing behaviors and anxiety and/or reducing amygdala volume in adopted children. It is possible that the symptoms of an enlarged amygdala (internalizing behaviors and anxiety, according to the current study) could be lessened even without a change in amygdala volume. Finding a break in this amygdala-behavioral problem correlation by use of post-adoption interventions would be an intriguing finding.

The Tottenham et al. study is important because not only does it find larger amygdala volume in the late-adoption group, but it finds an overall correlation between age at adoption and amygdala volume. On top of that, the study finds that higher amygdala volume is related to higher parental ratings on the behavioral questionnaires. These three components make this study especially novel.

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References

Belsky, J. (2010). Experiencing the lifespan (2^nd ed.). New York. Worth Publishers.

Hansell, J., & Damour, L. (2008). Abnormal psychology (2^nd ed.). United States of America.

Wiley & Sons, Inc.

Tottenham, N., & et al. (2009). Prolonged institutional rearing is associated with atypically

large amygdala volume and difficulties in emotional regulation. Journal compilation.

Retrieved from: https://ctools.umich.edu/access/content/group/da5a970e-dbf5-4f4d-8d72

d8280f4c505f/Paper%20Assignment%20_2/Tottenham%20et%20al%202010.pdf

Yurgelin-Todd, D. A., & Killgore, W. D.S. (2006). Fear-related activity in the prefrontal cortex

increases with age during adolescene: A preliminary fMRI study. Neuroscience letters.

Retrieved from: https://ctools.umich.edu/access/content/group/da5a970e-dbf5-4f4d-8d72-d8280f4c505f/Articles%20for%20Presentations/Yurgelun-Todd%20Killgore%202006.pdf

Hands

This is what I'm working on now: hands. I have 5-6 more of these hands to make and paint after these two, which is doable. You may have noticed the white hand paper cutouts acting as placeholders in the installation mockup pictures below. Those signify where these 3D, painted hands will go. So far I like how the look of the hand. It's distorted, but very real at the same time. Cool.

These next shots are post-mockup, and show me in progress putting finishing layers on the face and bodies,trying to make them look handmade, but still polished.

More Images

Prepare yourself for a lot of images

These last two are before the installation mock-up

My public, I've ignored you. It's not for not working....I just am really bad at remembering to share my progress. I feel that the last two months have been productive, in that I've been able to ease my anxiety from the beginning of this semester and actually believe in what I'm working on. Sometimes when I am in the midst of creating something personal as artwork, I wonder if it is valid and/or important. I couldn't stop thinking of what Endi said to me near the beginning of IP. I don't remember the details, but it was along the lines of "So what?" I think I've made my work more important in my eyes, and hopefully in others'. I think the dolls I'm making are bridging the boundary of craft and fine art, and referencing each in interesting ways. I remember when we had those group switch meetings last October. I was in Hannah's group,and she questioned how I would make it evident that my dolls weren't cute craft projects (heaven forbid!). I don't like putting down "craft", as much of my techniques and materials are essentially craft-based. Virtually all of my materials could be obtained by a trip to Joann Fabrics or Michaels, and I think my ability to paint on a 3-d, curved surfaces comes from my years of training in painting little ceramic statuettes with my grandmas and mod-podging easter knick-knacks with mom. So instead of shunning arts and crafts, I embrace them. I would be lost without them.

Another wonderful event in my life has occurred. I have been accepted into Wayne State's Art Therapy/Counseling program. By the time I am finished, I will be a licensed counselor and board certified art therapist. I found out last week, and it has given me a bit of a boost in confidence. My motivation is to finish this project and finish it well so that I can start the rest of my life. Wow.

Pictures (a lot of them to make up for lost time) will be coming soon.

Another paper related to attachment I wrote

The study conducted in 2009 by Zeanah and colleagues researching Romanian preschool children attempted to measure whether switching children from institutional care to foster family care would decrease the prevalence of psychiatric disorders at age 54 months. This study is especially new and important to the field, as it measures and controls for the institutional caregiving setting before the child is fostered out, instead of focusing on the child once he or she leaves the institution. This study also assesses the onset of several psychiatric disorders instead of limiting the number of disorders studied to just one (Zeanah et al. 2009). In addition, under normal circumstances children are not randomized when selected by adopters, which potentially leaves the most heavily impaired children within the institution and out of the adoption study. This study randomizes the placement of the children into separate groups: those placed in foster care and those who remained in institutional care. For further control, the study also compares both of these groups to a group of never-institutionalized Romanian children of the same age (Zeanah et al. 2009).

The total number of participants recruited from the institutions was 187. Due to medical reasons for exclusion, adoption, drop-outs, and missing data, 111 children were included in the final form of the study: 52 were randomized to remain in institutional care and 59 were randomized and placed into foster care (Zeanah et al. 2009). This foster care program was established as a part of the study, as no substantial system was in place. Age, sex, birth weight and other factors were virtually identical between the two groups. The main difference between the two groups was the high ratio of children to caregivers in institutions, with institutions having less one-on-one time and less stable, emotional bonding than foster care (Zeanah et al. 2009). The researchers were interested in this difference and its role in the appearance of psychiatric disorders later in childhood at 54 months. At this age, these groups were compared to the control group of never-institutionalized children, which consisted of 59 children in the final number analyzed. Age, sex, place of birth, and other factors remained consistent with the first two groups, with major differences occurring in birth weight of the children being compared (Zeanah et al. 2009).

This study was a longitudinal study that tracked and compared the diagnoses of various DSM-IV-TR disorder symptoms between the groups according to the Preschool Age Psychiatric Assessment (PAPA). The PAPA is a caregiver report that relies on rigid, standardized questions. Symptoms of potential disorders were recorded and watched over time by the primary caregiver (or caregiver who knows the child best) to assess proper diagnoses if needed (Zeanah et al. 2009). The types of disorders measured for were divided into three categories: “externalizing disorders”, such as ADHD, oppositional defiant disorder, and conduct disorder, “internalizing disorders”, such as depression and anxiety disorders, and “any disorder”, which could include any of the aforementioned disorders in addition to sleep disorders, enuresis, encopresis, and reactive attachment disorder (Zeanah et al. 2009 pp 780).

The results of this study show a significant difference between both groups that came from the institutions from the outset (both those who remained in institutional care and those who were placed in foster care) and the never-institutionalized children. Those who had any experience with institutional care were much more likely to develop any kind of disorder that the study measured (Zeanah et al. 2009). This result suggests that children raised in institutional care are at higher risk for developing psychiatric disorders in childhood due to the less than ideal conditions and quality of care provided.

A second result of the study reveals differences between the children who were placed in foster care and the children who were chosen to remain institutionalized. Internalizing disorders were significantly more prominent in the group of children who remained institutionalized than the foster care group (Zeanah et al. 2009). This is the most intriguing finding of the study, as it suggests that placing an abandoned child in foster care may help protect him/her from childhood onset of depression and anxiety disorders (the internalizing disorders). The researchers noted that the foster care families involved in the study were instructed to be nurturing, which in combination with the stable and constant care of one or two parental figures, may have provided suitable conditions for attachment to form (Zeanah et al. 2009).

Attachment is defined as the “powerful bond of love between a caregiver and child (or between any two individuals)” (Belsky 2009 pp 111). This is an important idea to consider when discussing this study, as it is really one of the major factors that could be influencing the significant improvement of the rates of internalizing disorders in the foster care group of children. With the nurturing, stable environment that foster care provides over nonindividualized care in institutions, attachment is more likely to form. In her book Experiencing the Lifespan, Janet Belsky describes attachment as necessary to develop and interact with others normally in order to “live fully” (Belsky 2009 pp 111). This suggests that attachment in early childhood is essential not only for healthy childhood functioning, but is essential as a foundation to live the rest of the lifespan in similar fashion. In relation to the Zeanah study, the increased chances of the formerly institutionalized children forming attachment when placed in foster care is a great step forward in providing these children with the foundation to experience better future interpersonal relationships and protect against internalizing disorders.

Harlow’s classic study of motherless monkeys shows disturbances in this formation of attachment, and suggests possible explanations for the significant increase in psychiatric disorders found in childhood with a history of institutionalization. These baby monkeys were separated from their mothers at birth and were isolated in cages with a choice of two mothers: a soft cloth monkey mother that provided comfort but no food, and a wire monkey mother that offered no comfort, but provided food. The baby monkeys chose to cling to the cloth, comforting mother over the wire mother most of the time. However, without real motherly contact, these monkeys were not given the interpersonal tools to cope with other monkeys, mate, and have children of their own without insemination. Even then, the monkeys became abusive mothers themselves (Belsky 2009). This shows a severe outcome that suggests that children in institutional care who do not form proper attachments could more readily develop the psychiatric disorders measured in the study, which could coincide/influence the struggle to relate to others in forming meaningful relationships.

A limitation of the study is the possible differential treatment that may have occurred between boys and girls in foster care. Girls fared better overall in lower rates in any category of disorders, which was supported by the never-institutionalized control group. However, there was no significant difference between control group boys and girls in the measure for internalizing disorders, including depression and anxiety disorders (Zeanah et al. 2009). This contradicts the findings comparing the foster care and institutional care for the boys, which show results that the boys showed no significant improvement between foster care and institutional care with the internalizing disorders, while the girls did show improvement if placed into the foster care group (Zeanah et al. 2009). This could potentially be explained by differential treatment between boys and girls in the foster care setting. Foster parents may have been more supportive or nurturing toward girls, while being less understanding of depressive or anxious symptoms in boys. This could result in inflation of symptom reporting in boys, or alternatively become an environment where the true symptoms could worsen. While it is difficult to standardize foster care, perhaps another study can be done to investigate this potential bias further. If it is true that the expectations of caregivers toward boys and girls differ in relation to internalizing disorders, special education and precautions can be offered to foster families to help young boys adjust to their new lives.

This study done by Zeanah et al. is an important step to understanding how institutionalized care for abandoned children can be improved. The significant findings in the reduction of internalizing disorders by placing children in institutions into foster families hint that an emphasis on attachment formation in early childhood is important in the prevention of depression and anxiety, and possibly interpersonal problems throughout the lifespan.

Works Cited

Zeanah et al., Initials. (2009). Institutional rearing and psychiatric disorders in Romanian preschool children. Am J Psychiatry, 166(7), Retrieved from https://ctools.umich.edu/portal/site/da5a970e-dbf5-4f4d-8d72-d8280f4c505f/page/ba3077c6-365a-488b-b4e4-53384beccc55

Belsky, J. (2010). Experiencing the lifespan. New York, NY: Worth Publishers.

Sketch

Alright. This is a sketch I did of what I want to do with the final form of my IP. I was playing around with a larger size of head that I made and I actually am close to finishing it. The most salient feature of that doll was how it could stand up. I rested its heavy head on the seat of the chair I have in my studio, and it hung there in space, supported by gravity and the weight of its head. I was really interested in this gravity and the visual impact it has.

It says something important about attachment in its heaviness, as if to say "I rely on you". I started sketching, and I came up with these houses which act similarly to the chair in its support, while lending a setting somewhat for my dolls. House, home, reliance, support, and all of the dolls in this family relying on this house shape together. I'm thinking about either building the house shapes out of wood and plexi (for the roof top), or out of all plexi. I really like the texture of wood, and I think it would complement the dolls nicely.

The other head shapes are the people who connect. Solid attachments, bad attachments. I'm exploring the people who have influenced my life and my family's lives and made us who we are. So, that is an update of my thoughts for this project. I'll post a picture of the doll I made soon.

Wow, okay. So I just remembered that I had a blog. I've been going through a lot of stages since my last post, cycling between "how in the world am I going to make this presentable to an actual audience?", "my project isn't going anywhere", and "I feel like I've been explaining and explaining my idea so much that the joy isn't there anymore". I think those things are natural to go through when working on a project this long. It's not that I'm not focused or driven--I'm very much so, but with everything else going on with trying to structure my life, some other things need to come first sometimes for my mind to become clear. For example, I haven't heard from my boss in about a month pertaining to whether or not I still have my job. I rely on that income for a number of things--one being funding for my project. Secondly, I've been trying to get all my stuff together to apply to grad school and it's difficult to work on IP when writing stuff for that, applying for new jobs, and generally balancing work for my other classes.

Aside from that, I'm great. Things are starting to pick up in my studio. I've decided to just produce a lot of dolls-more full-bodied ones and see where that takes me. Endi suggested the use of photography to add another element to my installation, but I'll see where making these things takes me. Okay, I'll post pictures next time.