Arnett Anne B, Antúnez Martín, Zeanah Charles, Fox Nathan A, Nelson Charles A
Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
J Child Psychol Psychiatry. 2025 Jul;66(7):967-979. doi: 10.1111/jcpp.14110. Epub 2025 Jan 11.
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.
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.
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.
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.
注意力缺陷多动障碍（ADHD）是有早期机构照料史儿童中常见的神经发育结果。先前针对机构照料儿童的研究表明，儿童期身体生长加速是ADHD结果的一个风险因素。
本研究调查了参与布加勒斯特早期干预项目（NCT00747396，clinicaltrials.gov）的随机分配到寄养治疗组（n = 59）或常规照料组（n = 54）的机构照料儿童以及从未接受过机构照料的儿童（n = 64）的身体和神经生理生长轨迹。参与者在从婴儿期到青春期的六个时间点完成了身体和脑电图（EEG）评估，以及在54个月和12岁时间点进行的结构化诊断访谈。估计了一系列多层次生长模型和交叉滞后路径模型，以研究身体和神经生理成熟、治疗组、寄养安置年龄与ADHD诊断结果之间的关联。
27%的机构照料儿童在一个或两个时间点符合ADHD的研究标准。身高和头围生长缓慢、延长与ADHD以及寄养安置延迟有关。与常规照料相比，寄养安置与阿尔法峰值频率的成熟有关，但与ADHD无关。在随机分配到寄养治疗组的儿童中，患有ADHD的儿童平均θ-β比率较低。没有证据表明身体快速成熟会导致非典型皮层活动。
从婴儿期到青春期，身体生长延迟、延长以及非典型神经生理学与机构照料儿童的ADHD有关，且超出了寄养的保护作用。
