Early Childhood Deprivation Research Articles

Prison Deprivation in the Infant and Early Childhood: Problem Statement

The article raises the problem of deprivation in infants and early childhood, whose mothers are in places of confinement. Mother is in a place of confinement under a court sentence. The child is in the place of confinement without being guilty before the society and the state. Frequently, the child is separate from his mother. The mother can visit the child only in her free time, if she has an opportunity and desire for this. The child does not have full communication with the mother, her love. As a result, psychophysical retardation of the childs development is noted. The mother, who is deprived of the opportunity to stay with the child, sometimes commits disciplinary offenses, which ever more restricts her opportunity to stay with the child. In order to protect motherhood and childhood, in the domestic penitentiary system mother-and-child homes are created where joint staying of the mother and the child is made possible. The results of the study testify a positive effect of such practices on the behavior of the convicted mother and the development of the child deprived of liberty.

Early psychosocial deprivation and adolescent risk-taking: The role of motivation and executive control.

Risk-taking in adolescence has been often associated with early life adversities. However, the impact of such macrolevel factors on risk behavior has been rarely studied in humans. To address these gaps we recruited a sample of young adolescents who were part of a randomized control trial of foster care. Children institutionalized at or soon after birth were randomly assigned either to be removed from institutions and placed into a family or foster care intervention or to remain in institutions receiving care as usual. These children were subsequently followed up through 12 years of age and compared with a sample of children who had never been institutionalized. Using this sample, we examined the impact of early childhood deprivation on risk-taking behavior and explored the role of motivation (i.e., sensation seeking) and executive control (i.e., planning). Early psychosocial deprivation decreased engagement in risk-taking among young adolescents by reducing sensation seeking, a motivation often associated with risk-taking in adolescence. The impact of early psychosocial deprivation on sensation seeking and consequently on engagement in risk-taking was further reduced by its deleterious effects on executive control. These findings challenge the traditional view according to which risk behavior is a maladaptive response to adversities and suggest that it may represent adolescents' attempts to fulfill important motivations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Early sleep deprivation and attention-deficit/hyperactivity disorder.

This study aims to study prospectively specific sleep patterns and risk of ADHD after adjusting for potential confounders such as obstructive sleep apnoea (OSA) and methylphenidate use. A population-representative sample of 514 Chinese preschool children was recruited when in kindergarten (K3). Parents reported on their socioeconomic status and children's sleep duration. The cohort was reassessed 3 years later when the children were in Grade 3 (P3). Parents reported on children's sleep patterns and ADHD symptoms. Information on OSA diagnosis and methylphenidate use was retrieved from health records. Among the 514 parent-child dyads (mean [SD] age, 5.52 [0.33] years), 411 were reassessed (80.0% retention; 9.35 [0.33] years) at follow-up. There were no significant baseline differences between follow-up and drop-out groups. A gradient relationship was observed between probable ADHD in P3 and sleep duration in K3. The risk of probable ADHD was 15.5 per 100 for children with <8 h of sleep in K3, whereas it was 1.1 per 100 for children with 11-12 h of sleep in K3. The adjusted risk ratio was 14.19 (p = 0.02). Sleep deprivation in early childhood is associated with higher risk of ADHD in middle childhood.

Chains of risk for alcohol use disorder: Mediators of exposure to neighborhood deprivation in early and middle childhood

Our goal was to test a cascade model to identify developmental pathways, or chains of risk, from neighborhood deprivation in childhood to alcohol use disorder (AUD) in young adulthood. Using Swedish general population data, we examined whether exposure to neighborhood deprivation during early and middle childhood was associated with indicators of social functioning in adolescence and emerging adulthood, and whether these were predictive of AUD. Structural equation models showed exposure to neighborhood deprivation was associated with lower school achievement during adolescence, poor social functioning during emerging adulthood, and the development of AUD for both males and females. Understanding longitudinal pathways from early exposure to adverse environments to later AUD can inform prevention and intervention efforts.

Adult disinhibited social engagement in adoptees exposed to extreme institutional deprivation: examination of its clinical status and functional impact.

BackgroundEarly-life institutional deprivation produces disinhibited social engagement (DSE). Portrayed as a childhood condition, little is known about the persistence of DSE-type behaviours into, presentation during, and their impact on, functioning in adulthood.AimsWe examine these issues in the young adult follow-up of the English and Romanian Adoptees study.MethodA total of 122 of the original 165 Romanian adoptees who had spent up to 43 months as children in Ceauşescu's Romanian orphanages and 42 UK adoptees were assessed for DSE behaviours, neurodevelopmental and mental health problems, and impairment between ages 2 and 25 years.ResultsYoung adult DSE behaviour was strongly associated with early childhood deprivation, with a sixfold increase for those who spent more than 6 months in institutions. However, although DSE overlapped with autism spectrum disorder and attention-deficit hyperactivity disorder symptoms it was not, in itself, related to broader patterns of mental health problems or impairments in daily functioning in young adulthood.ConclusionsDSE behaviour remained a prominent, but largely clinically benign, young adult feature of some adoptees who experienced early deprivation.

Neighborhood Deprivation during Early Childhood and Conduct Problems in Middle Childhood: Mediation by Aggressive Response Generation.

The tremendous negative impact of conduct problems to the individual and society has provided the impetus for identifying risk factors, particularly in early childhood. Exposure to neighborhood deprivation in early childhood is a robust predictor of conduct problems in middle childhood. Efforts to identify and test mediating mechanisms by which neighborhood deprivation confers increased risk for behavioral problems have predominantly focused on peer relationships and community-level social processes. Less attention has been dedicated to potential cognitive mediators of this relationship, such as aggressive response generation, which refers to the tendency to generate aggressive solutions to ambiguous social stimuli with negative outcomes. In this study, we examined aggressive response generation, a salient component of social information processing, as a mediating process linking neighborhood deprivation to later conduct problems at age 10.5. Participants (N=731; 50.5% male) were drawn from a multisite randomized prevention trial that includes an ethnically diverse and low-income sample of male and female children and their primary caregivers followed prospectively from toddlerhood to middle childhood. Results indicated that aggressive response generation partially mediated the relationship between neighborhood deprivation and parent- and teacher-report of conduct problems, but not youth-report. Results suggest that the detrimental effects of neighborhood deprivation on youth adjustment may occur by altering the manner in which children process social information.

Severe psychosocial deprivation in early childhood is associated with increased DNA methylation across a region spanning the transcription start site of CYP2E1.

Exposure to adverse rearing environments including institutional deprivation and severe childhood abuse is associated with an increased risk for mental and physical health problems across the lifespan. Although the mechanisms mediating these effects are not known, recent work in rodent models suggests that epigenetic processes may be involved. We studied the impact of severe early-life adversity on epigenetic variation in a sample of adolescents adopted from the severely depriving orphanages of the Romanian communist era in the 1980s. We quantified buccal cell DNA methylation at ~400 000 sites across the genome in Romanian adoptees exposed to either extended (6–43 months; n=16) or limited duration (<6 months; n=17) of severe early-life deprivation, in addition to a matched sample of UK adoptees (n=16) not exposed to severe deprivation. Although no probe-wise differences remained significant after controlling for the number of probes tested, we identified an exposure-associated differentially methylated region (DMR) spanning nine sequential CpG sites in the promoter-regulatory region of the cytochrome P450 2E1 gene (CYP2E1) on chromosome 10 (corrected P=2.98 × 10−5). Elevated DNA methylation across this region was also associated with deprivation-related clinical markers of impaired social cognition. Our data suggest that environmental insults of sufficient biological impact during early development are associated with long-lasting epigenetic changes, potentially reflecting a biological mechanism linking the effects of early-life adversity to cognitive and neurobiological phenotypes.

Is Semantics Affected by Missing a Critical Period? Evidence from the Persian Deaf.

The present study aims to explore the semantic knowledge of a group of Iranian deaf individuals who, due mainly to auditory deprivation did not acquire language normally in early years of their life. The participants were ten deaf and a matched number of hearing individuals as control group. A test of five tasks was administrated to assess their knowledge of vocabulary, collocation, semantic categorizations, semantic features, and proverbs. Although the results indicated a significant difference between the deaf and the hearing group, a between- group comparison of each task revealed no significant difference between the deaf and hearing participants in the number of errors in vocabulary, collocations, semantic categorization, and semantic features. The only task in which deaf participants did significantly worse than the control group was that of proverbs. Therefore, it could be argued that, language deprivation in early childhood does not have the same effect on different components of our linguistic knowledge and that the acquisition of semantics may well continue beyond puberty.

Childhood trauma in bipolar disorder

Introduction Bipolar disorder is a multi-factorial disease and has a heterogeneous clinical presentation. Currently, the negative impact of stress on the evolutionary course of the disease is increasingly being recognized. However, studies exploring the childhood trauma in bipolar disorder are, so far, few and inconclusive. Objectives We sought to compare injury rates during childhood in adults with bipolar disorder compared with a healthy control group to study the impact of childhood trauma on the clinical evolution of bipolar disorder. Methods A retrospective assessment of childhood trauma was conducted using the Childhood Trauma Questionnaire (CTQ) with 30 patients with bipolar disorder who are stabilized and who following post treatment in the psychiatric unit F Razi hospital and 30 healthy subjects matched based on age and sex. Results Significantly higher rates of childhood trauma were observed in bipolar patients compared to the control group. The scores for sexual abuse and emotional neglect differ significantly between the two groups. Psychological violence was predictive of early onset bipolar disorder. Associations with clinical severity were less clear. Conclusion Emotional deprivation in early childhood appears to be significantly associated with bipolar disorder. More thorough studies especially on the neurobiological consequences of childhood trauma would be necessary.

Guest editorial: Addressing child poverty

THIS SPECIAL EDITION OF Enterprise Development and Microfinance is concerned with the question of investing in children born into and growing up in poverty – and how children in poor families and settings can better be supported to make successful transitions into good livelihoods and decent work as young adults. Across all regions, child poverty has long been an unduly neglected issue in national policy. Its implications for economic development have been underestimated and its impacts on societies, future prosperity, and for disadvantaged children themselves have been poorly understood. Within the global push toward poverty-reduction goals, the persistence of poverty among children needs to be addressed as an urgent priority. Children are by far the most vulnerable to poverty’s damaging effects: harms suffered by poor children, such as stunting in early childhood and learning deprivation, are hard to recover from in later years; such deprivations have major costs, not only for the young people affected but also for their whole societies; and poverty’s effects are powerfully transmitted to the next generation in turn. The elimination of extreme poverty among children cannot be safely left to the forces of economic growth alone. Particularly in quite unequal societies, rising average incomes may not translate powerfully into gains for the poorest children, while improvements in basic services, if they occur, may fail to reach the most deprived. Specific, strongly targeted interventions for the poorest families and children are needed to ensure that girls and boys and young people around the world are able to fulfil their potential, including as future entrepreneurs and wealth-creators. Of the more than 1 billion people currently living in extreme income-poverty, almost half are children, while in low-income countries, some 52 per cent of under-12s live in income-poverty, compared to 42 per cent of people over this age (Olinto et al., 2013). Rates of poverty are significantly higher among children compared to adults in many rich-world countries, too (UNICEF, 2012). Such patterns will continue unless there is a concerted focus on child poverty in its own right. Low family economic status is associated with poor outcomes and major deprivations in young lives. Children born in the lowest household wealth quintile in developing countries are over twice as likely to die before the age of five years as their counterparts in the top quintile, while the prevalence of malnutrition (low weight for age) among young children is about two-and-a-half times higher in the poorest families in developing countries compared to the richest (UNICEF, 2010). The physical stunting of children is not only a poverty trap for them as individuals; it also represents a fundamental squandering of human potential. It leads to long-term, largely irreversible damage – through poorer school performance, lower work capacity, and diminished adult productivity. Girls who suffer under-nutrition

Stunting and Marginalisation and Lack of Resiliency

Malnutrition across the world is a global issue but in the developing countries it is catastrophic. Poverty affects nutrition and nutrition affects poverty, while income poverty is important to nutrition it is not strongly correlated, it is here we begin this interdisciplinary dialogue on a growing phenomenon in Asia called stunting. Stunting or chronic under nutrition, resulting in growth retardation is indicated by height for- age. Nearly 40 percent of the children in SAARC countries are engulfed in poor conditions for growth and development. Clinical etiology suggests that lack of nutrition, presence of infection and lack of mother – infant interaction insufficient food supply both in quantity and quality and recurrence of infectious diseases results in stunting or chronic under nutrition. Stunting, as a manifestation of deprivation in early childhood, is a common problem among young children. We suggest that poverty and lack of resources may predispose a child to maladjustment in the grown-up society, lacking in resiliency. This paper examines the relationship between poverty, marginalization and health in the context of stunting, under weight and wasting among children and malnutrition among women and adolescent girls lacking in resilience.

Early development, stress and depression across the life course: pathways to depression in a national British birth cohort.

The aetiology of depression is multifactorial, with biological, cognitive and environmental factors across the life course influencing risk of a depressive episode. There is inconsistent evidence linking early life development and later depression. The aim of this study was to investigate relationships between low birthweight (LBW), infant neurodevelopment, and acute and chronic stress as components in pathways to depression in adulthood. The sample included 4627 members of the National Survey of Health and Development (NSHD; the 1946 British birth cohort). Weight at birth, age of developmental milestones, economic deprivation in early childhood, acute stressors in childhood and adulthood, and socio-economic status (SES) in adulthood were assessed for their direct and indirect effects on adolescent (ages 13 and 15 years) and adult (ages 36, 43 and 53 years) measures of depressive symptoms in a structural equation modelling (SEM) framework. A structural equation model developed to incorporate all variables exhibited excellent model fit according to several indices. The path of prediction from birthweight to age of developmental milestones to adolescent depression/anxiety to adult depression/anxiety was significant (p<0.001). Notably, direct paths from birthweight (p=0.25) and age of developmental milestones (p=0.23) to adult depression were not significant. Childhood deprivation and stressors had important direct and indirect effects on depression. Stressors in adulthood were strongly associated with adult depression. Depression in adulthood is influenced by an accumulation of stressors across the life course, including many that originate in the first years of life. Effects of early-life development on mental health appear by adolescence.

EPA-0342 – Protective and risk factors of schizophrenia

Introduction Manifestation of schizophrenia significant depends on whether the impact factors that trigger the disease on individual. The influence of protective factors can reduce the risk manifestation of schizophrenia and even improve clinical presentation. Aims To study the impact environmental factors, in risk and protective role, on manifestation and clinical presentation of schizophrenia spectrum disorders (F 20 - F 29). Method We recruited 108 cases (50 females; 58 males) of schizophrenia spectrum disorders (F20 - F 29) aged 17 to 35 years. And control was included 46 risk group persons, who had genetic predisposition, but were not ill. The relatives and persons were interviewed for perinatal pathology and bird, child and adolescent history factors. Results Among the main group environmental factors were predominantly: maternal age at birth of 40 years 20.37 % (N = 22), transferred diseases during mother pregnancy 11.1% (N = 12), the availability of social deprivation, child abuse and psychological trauma in early childhood 38.9% (N=42), consuming alcohol and cannabis in adolescence 19.4% (N=21). In addition, psychological trauma in childhood and using psychoactive substances are correlated with early social disadaptation in schizophrenia. On the other hand, the projective factors were high levels of intellect and social functioning 60.9% (N = 28), emotional support from parents 87% (n = 40), excluding the use of toxic substances 89.1% (N = 41). Conclusions Therefore, lifestyle changes that encourage minimized exposure to known environmental factors may reduce the risk for schizophrenia.

Spectral-domain optical coherence tomography analysis in deprivational amblyopia: a pilot study with unilateral pediatric cataract patients

To investigate whether macular and peripapillary retinal nerve fiber layer (RNFL) structure differs among deprivational amblyopic eyes, fellow non-amblyopic eyes, and age-matched normal eyes, using spectral-domain optical coherence tomography (SD-OCT). Macula and optic disc of 14 unilateral pseudophakic children with deprivational amblyopia, and 14 age-matched normal children (mean age, 7.45 ± 2.57 years) were scanned with Cirrus(TM) HD-OCT. Macular, RNFL, and macular ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured, and compared between the eyes after correction for axial length-related magnification errors. The average RNFL thickness tended to be greater in amblyopic eyes (99.64 ± 10.11 μm) than in fellow non-amblyopic eyes (97.28 ± 12.34 μm) and normal eyes (95.38 ± 9.74 μm), but did not show statistical significance (p = 0.429, p = 0.286 respectively). The nasal RNFL thickness was significantly greater in amblyopic eyes (75.84 ± 19.22 μm) than in fellow non-amblyopic eyes (63.42 ± 14.05 μm, p = 0.037) and normal eyes (62.38 ± 9.65 μm, p = 0.043). The central macular thickness in amblyopic eyes (237.05 ± 37.74 μm) showed no significant differences compared to those of fellow non-amblyopic eyes (226.67 ± 34.71 μm) and normal eyes (233.74 ± 27.11 μm) (p = 0.137, p = 0.792 respectively). The macular GCIPL thickness showed no significant difference among the amblyopic, fellow non-amblyopic, and normal eyes (average; 78.94 ± 6.35 μm vs 78.77 ± 6.43 μm vs 82.22 ± 5.00 μm respectively, p > 0.05). SD-OCT analysis of deprivational amblyopic eyes with unilateral pediatric cataract demonstrated significant increase in nasal RNFL thickness compared to fellow non-amblyopic eyes and age-matched normal eyes. The macular and macular GCIPL thickness did not show any significant difference. Taken together, monocular pattern deprivation in early childhood may have changed the nasal peripapillary RNFL structure.

Short Leg Length, a Marker of Early Childhood Deprivation, Is Associated With Metabolic Disorders Underlying Type 2 Diabetes

OBJECTIVEShort leg length, a marker of early childhood deprivation, has been used in studies of the association of early life conditions with adult chronic disease risk. The objective of this study was to determine the cross-sectional associations of leg length with measures of insulin sensitivity and β-cell function.RESEARCH DESIGN AND METHODSSubjects (n = 462) at risk for type 2 diabetes were recruited into the PROspective Metabolism and ISlet cell Evaluation (PROMISE) longitudinal cohort. Leg length was calculated from sitting and standing height at the 3-year clinical examination. Glucose tolerance status was determined using an oral glucose tolerance test. Insulin sensitivity was assessed using homeostasis model assessment of insulin resistance (HOMA-IR) and the Matsuda insulin sensitivity index (ISI), while the insulinogenic index over HOMA-IR (IGI/IR) and the insulin secretion sensitivity index 2 (ISSI-2) determined β-cell function. Multiple linear regression analysis was conducted, adjusting for covariates including age, sex, ethnicity, family history of diabetes, waist, and weight.RESULTSLeg length and leg-to-height ratio were significantly associated with HOMA-IR (β = −0.037, β = −10.49, respectively; P < 0.0001), ISI (β = 0.035, β = 8.83, respectively; P < 0.0001), IGI/IR (β = 0.021, P < 0.05; β = 7.60, P < 0.01, respectively), and ISSI-2 (β = 0.01, P < 0.03; β = 3.34, P < 0.01, respectively) after adjustment for covariates. The association of shorter leg length with lower insulin sensitivity was most evident for those with high waist circumferences.CONCLUSIONSShorter legs were independently associated with lower insulin sensitivity and β-cell function, suggesting that early childhood deprivation may increase the risk of developing diabetes.

Deprivation, timing of preschool infections and H. pylori seropositivity at age 49-51 years: the Newcastle thousand families birth cohort

BackgroundHelicobacter pylori infection is acquired in early childhood and persists for life (or until eradication treatment is taken). Seropositivity of H. pylori at age 49-51 years was assessed in relation to socio-economic deprivation in early life and the timing of other childhood infections common at that time.MethodsProspectively collected socio-economic and morbidity data from the Newcastle Thousand Families study, a birth cohort established in 1947. H. pylori IgG seropositivity was assessed at 49-51 years and examined in relation to both whether the individual had been diagnosed with one of measles, mumps or chicken pox, and, if so, the age at first infection. This was done in logistic regression models, allowing adjustment for socio-economic status and housing quality in childhood.ResultsAdult H. pylori status was strongly linked to disadvantaged socio-economic status in early life (p ≤ 0.002), unlike measles, mumps and chicken pox which showed no associations. Early measles infection was independently associated with H. pylori seropositivity (p = 0.01).ConclusionsOf the four infectious diseases that we have studied, it appears that H. pylori differs from the others by the strength of association with socio economic deprivation in early childhood.Our findings further highlight the complex interaction between measles, childhood infections and other non-microbiological factors that occur within a whole population. These data suggest a strong association between H. pylori and deprivation and raise the possibility of an interaction between early measles exposure and increased risk of exposure to H. pylori infection.

Childhood Poverty and Blood Pressure Reactivity to and Recovery From an Acute Stressor in Late Adolescence

Childhood deprivation is inimical to health throughout the life course. Early experiences of stress could play a role in health inequalities. An important aspect of childhood poverty that has not received much attention is cardiovascular reactivity to and recovery from acute stressors.Piecewise, multilevel growth curve regression was used to examine blood pressure reactivity to and recovery from a mental arithmetic task among late adolescents (mean [standard deviation] = 17.3 [1.0] years, n = 185) as a function of early childhood poverty (9 years). We also tested whether exposure to family conflict at age 13 years mediated expected linkages between childhood poverty and adolescent blood pressure reactivity and recovery to an acute stressor.Blood pressure reactivity was unaffected by household income during childhood, but late adolescents with lower household income during childhood showed slower systolic (b = -0.29, p = .004) and diastolic (b = -0.19, p = .002) recovery. These results include age and sex as statistical covariates. The significant poverty impact on systolic but not on diastolic blood pressure recovery was mediated by exposure to family conflict (95% confidence interval = - 0.1400 to - 0.0012).We show that late adolescents who grew up in poverty have delayed blood pressure recovery from an acute stressor. Furthermore, childhood exposure to family conflict, a well-documented component of early childhood deprivation, accounted for some of the adverse effects of childhood poverty on stressor recovery among these adolescents. We discuss the importance of considering physiological stress accompanying early experiences of deprivation in thinking about health inequalities.

The Lady in the Carriage: Trauma, Embodiment, and the Drive for Resolution

The Lady in the Carriage: Trauma, Embodiment, and the Drive for Resolution

The influence of language deprivation in early childhood on L2 processing: An ERP comparison of deaf native signers and deaf signers with a delayed language acquisition

BackgroundTo examine which language function depends on early experience, the present study compared deaf native signers, deaf non-native signers and hearing German native speakers while processing German sentences. The participants watched simple written sentences while event-related potentials (ERPs) were recorded. At the end of each sentence they were asked to judge whether the sentence was correct or not. Two types of violations were introduced in the middle of the sentence: a semantically implausible noun or a violation of subject-verb number agreement.ResultsThe results showed a similar ERP pattern after semantic violations (an N400 followed by a positivity) in all three groups. After syntactic violations, native German speakers and native signers of German sign language (DGS) with German as second language (L2) showed a left anterior negativity (LAN) followed by a P600, whereas no LAN but a negativity over the right hemisphere instead was found in deaf participants with a delayed onset of first language (L1) acquisition. The P600 of this group had a smaller amplitude and a different scalp distribution as compared to German native speakers.ConclusionsThe results of the present study suggest that language deprivation in early childhood alters the cerebral organization of syntactic language processing mechanisms for L2. Semantic language processing instead was unaffected.

IV. Growth Failure in Institutionalized Children.

Children within institutional care settings experience significant global growth suppression, which is more profound in children with a higher baseline risk of growth impairment (e.g., low birth weight [LBW] infants and children exposed to alcohol in utero). Nutritional insufficiencies as well as suppression of the growth hormone-insulin-like growth factor axis (GH-IGF-1) caused by social deprivation likely both contribute to the etiology of psychosocial growth failure within these settings. Their relative importance and the consequent clinical presentations probably relate to the age of the child. While catch-up growth in height and weight are rapid when children are placed in a more nurturing environment, many factors, particularly early progression through puberty, compromise final height. Potential for growth recovery is greatest in younger children and within more nurturing environments where catch-up in height and weight is positively correlated with caregiver sensitivity and positive regard. Growth recovery has wider implications for child well-being than size alone, because catch-up in height is a positive predictor of cognitive recovery as well. Even with growth recovery, persistent abnormalities of the hypothalamic-pituitary-adrenal system or the exacerbation of micronutrient deficiencies associated with robust catch-up growth during critical periods of development could potentially influence or be responsible for the cognitive, behavioral, and emotional sequelae of early childhood deprivation. Findings in growth-restricted infants and those children with psychosocial growth are similar, suggesting that children experiencing growth restriction within institutional settings may also share the risk of developing the metabolic syndrome in adulthood (obesity, Type 2 diabetes mellitus, hypertension, heart disease). Psychosocial deprivation within any care-giving environment during early life must be viewed with as much concern as any severely debilitating childhood disease.