The International Adoption Clinic conducts research examining outcomes for internationally adopted children throughout all stages.
Research Projects
Faculty
Research Projects
"Fetal Alcohol Spectrum Disorders in Children Residing in Russian Orphanages: A Phenotypic Survey" (Featured in the March 2006 issue of Alcoholism: Clinical and Experimental Research)
Background
Alcohol use in Russia is among the highest in the world. Over 600,000 children reside in institutional care in Russia, most of them in baby homes and orphanages. The actual prevalence of fetal alcohol spectrum disorders (FASD) among these children is unknown. Therefore, we performed a systematic survey of phenotypic features associated with prenatal alcohol exposure among institutionalized Russian children and related these findings to their growth, development, medical, and social histories.
Methods
Phenotypic screening was conducted of all 234 baby home residents in the Murmansk region of Russia (mean age 21+12.6 months). Phenotypic expression scores were devised based on facial dysmorphology and other readily observable physical findings. Growth measurements from birth, time of placement in the baby home, and at present were analyzed. In addition, the charts of 64% of the children were randomly selected for retrospective review. Information collected included maternal, medical, developmental, and social histories.
Results and conclusions
“Functional outcome and quality of life for internationally adopted children and their families” (2003-2004)
Tufts Medical Center's International Adoption Clinic conducted a new research study funded by the Deborah Munroe Noonan Memorial Fund. The study assessed school performance, behavior, cognition and family function in eight to ten year old children adopted from Eastern Europe, who had been in the U.S. for over five years. We included a broad spectrum of children performing at all different levels, by recruiting from clinic and community contacts. Parental participation helped determine the influence of family on outcome. No previous Tufts Medical Center affiliation was required.
Parents completed questionnaires and behavioral scales; the child completed standardized scales to determine cognition, performance and behavior. This half-day appointment at Tufts Medical Center also included a brief physical exam for each child. We requested recruitment of each child’s teacher, for his/her participation to complete a standardized questionnaire on child’s school behavior. This behavior scale will not be retained in any child’s school record, and was only utilized by our research team for this study (in order to ensure confidentiality).
"Neurodevelopmental Outcome of Russian Orphanage Children" (2004-2006)
We will be spending time implementing a training program for our Russian colleagues working in three orphanages. This is part of a large project funded by the National Institute of Health investigating brain disorders through the lifespan. Our intentions are to enhance the objective documentation, identification and research of growth and developmental delays, disorders and risk factors affecting outcome in orphanage children. Ultimately we hope to improve the lives of the children "left behind" by increasing orphanage staff awareness and involvement with children presenting with various risk factors.
"Nutritional Assistance of Nepali Children" (2004)
Dr. Laurie Miller traveled to Nepal over six months to develop a proposal to enhance the nutritional status of children, including those in orphanage care. This study is funded by the Collaborative Research Support Program (CRSP).
Faculty
Laurie C. Miller, MD, Associate Professor of Pediatrics
International Adoption
617-636-7285
Education/Training
|
Yale College, New Haven, CT |
BA |
1974 |
Psychology (cum laude) |
|
Ohio State University College of
Medicine, Columbus, OH |
MD |
1978 |
Medicine |
|
University of Minnesota,
Minneapolis, MN |
Residency |
1978-82 |
Pediatrics |
|
University of Minnesota,
Minneapolis, MN |
Fellowship |
1982-85 |
Pediatric Nephrology |
|
New England Medical Center,
Boston, MA |
Fellowship |
1985-86 |
Pediatric Rheumatology |
Research Interests
Dr. Miller's research addresses the health and well-being of children who have experienced adversity in early life. Some of these children have been adopted by American parents; some remain in institutional care (orphanages) in other countries, while others live in very impoverished families in Nepal. These children have usually had no prenatal care, probable prenatal exposure to drugs, alcohol, and/or maternal stress. After birth, the children often experience malnutrition, micronutrient deficiencies, infections, exposure to toxins, as well as environmental and emotional deprivation. She is interested in learning about risk and protective factors related to growth, developmental, emotional, and behavioral outcomes for the children and their families. Children are resilient and have a lot to teach us about the factors that make it possible to overcome early adversity. Dr. Miller and the other members of the International Adoption Division are presently designing a large-scale intervention for orphanages in Russia, particularly focused on children with fetal alcohol syndrome.
Key Publications
Vannier E, Miller LC, Dinarello CA. Histamine suppresses gene expression and synthesis of tumor necrosis factor alpha via histamine H2 receptors. Journal of Experimental Medicine 1991; 174:281-4.
Miller LC, Isa S, Vannier E, Georgilis K, Steere AC, Dinarello CA. Live Borrelia burgdorferi preferentially activate interleukin-1 beta gene expression and protein synthesis over the interleukin-1 receptor antagonist. Journal of Clinical Investigation 1992; 90:906-12.
Vannier E, Miller LC, Dinarello CA. Coordinated antiinflammatory effects of interleukin 4: interleukin 4 suppresses interleukin 1 production but up-regulates gene expression and synthesis of interleukin 1 receptor antagonist. Proceedings of the National Academy of Sciences of the United States of America 1992; 89:4076-80.
Miller LC, Lynch EA, Isa S, Logan JW, Dinarello CA, Steere AC. Balance of synovial fluid IL-1 beta and IL-1 receptor antagonist and recovery from Lyme arthritis. Lancet 1993; 341:146-8.
Miller LC. Caring for internationally adopted children. New England Journal of Medicine 1999; 341:1539-40.
Miller LC. International adoption: infectious diseases issues, Clin Infect Dis. 2005 Jan 15;40(2):286-93. Epub 2004 Dec 17., 2005.
Miller LC. International adoption, behavior, and mental health. JAMA, in press, 2005.