251 - The Discrepancy Between Cognitive and Adaptive Skills Following Severe Early Deprivation

Publication Number: 2241.251

Emily Zalimeni, Boston Children's Hospital, Brookline, MA, United States; Gabriela V. Miller, Boston Children's Hospital, Brookline, MA, United States; Elizabeth Harstad, Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, United States; Charles H. Zeanah, Tulane University, Metairie, LA, United States; Nathan A. Fox, University of Maryland, College Park, MD, United States; Charles a. Nelson, Boston Children's Hospital, brookline, MA, United States

Background: Children who experience profound neglect early in life, such as those raised in institutions, have been found to demonstrate deficient cognitive and adaptive skills, though early placement into foster care ameliorates some of these impacts. Qualitative observations from the Bucharest Early Intervention Project (BEIP) suggest children exposed to institutionalized care often present as higher functioning than formal cognitive testing indicates. This profile would deviate from research in populations without neglect exposure where adaptive skills, if discrepant, lag cognitive abilities.

Objective: To determine if discrepancies exist between cognitive and adaptive skills at 16-year follow-up in individuals remaining in institutions as compared to foster care (FCG) and never institutionalized (NIG) groups.

Design/Methods: We analyzed data from 118 participants in BEIP using the Vineland Adaptive Behavior Scales to assess adaptive and Wechsler Intelligence Scale for Children to assess cognitive skills. Discrepancy scores were calculated by subtracting Vineland domain standard scores from full-scale IQ (FSIQ). We conducted ANOVA and pairwise comparisons to examine discrepancy scores across three care groups: care-as-usual (ongoing institutionalization, CAUG), FCG, and NIG and between those ever institutionalized (EIG) and NIG. For discrepancies showing statistically significant group differences, we examined the group × intellectual functioning interaction, with intellectual functioning categorized as intact (FSIQ ≥85), borderline (FSIQ 71-84), or impaired (FSIQ ≤70).

Results: Daily Living Skills (DLS) discrepancy scores differed between the EIG and NIG (p = .01) and between CAUG, FCG, and NIG (p = .03). Pairwise comparisons revealed differences between all three groups (p < 0.01). The largest DLS > FSIQ discrepancy was found in the CAUG, followed by FCG, with a significant group × intellectual functioning interaction. There was no significant discrepancy between DLS and FSIQ in the NIG and no statistically significant group differences for the other Vineland domains.

Conclusion(s): Individuals who experienced severe early psychosocial deprivation (i.e., institutional rearing) demonstrate daily living skills that exceed cognitive abilities. This profile may be reflective of increased self-reliance as a compensatory mechanism for severe neglect. Moderation by intellectual functioning suggests this phenomenon is most pronounced in those with greater cognitive impairment. Standardized testing may underestimate functional capacities in this population with implications for support services.