Children With Early Severe Deprivation Benefit From High-Quality Foster Care

Children from the Bucharest Early Intervention Project randomized to foster care had less severe psychopathology and better cognitive and physical outcomes than their peers who remained in institutional care. Researchers presented the study, which synthesized data from nearly 20 years of assessments, at the American Psychiatric Association Annual Meeting in San Francisco, California, May 20-24, 2023.

“Our findings provide the most robust and comprehensive evidence to date that children exposed to severe early psychosocial deprivation benefit substantially when they receive enriching, family-based care,” wrote study presenter Kathryn L. Humphreys, PhD, EdM, an assistant professor at Vanderbilt University, Nashville, Tennessee, and coauthors.

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Researchers used an intent-to-treat approach to investigate the causal effects of foster care compared with institutional care for 136 children from institutions in Bucharest, Romania. The randomized controlled trial assigned 68 children, ages 6 months through 31 months at baseline, to foster care and followed 68 other children assigned to care as usual. (“The ethical dimensions of this study have been widely discussed by the study team and others,” the authors noted.) 

At ages 30 months, 42 months, 54 months, 8 years, 12 years, and between 16 and 18 years, participants were assessed for 5 types of psychopathology as well as IQ, physical growth, and brain electrical activity. In all, more than 7000 observations occurred over follow-up. Researchers were interested in quantifying the overall effect of the foster care intervention on children’s outcomes.

“The benefits of foster care for previously institutionalized children were remarkably stable across development,” researchers reported.

Specifically, IQ and disorders of social relatedness (reactive attachment disorder and disinhibited social engagement disorder) were the outcomes most influenced by foster care, with standardized coefficients ranging from 0.35 to 0.60, according to the study. In addition, foster care showed causal effects on children’s internalizing symptoms as well as physical growth. 

By encouraging foster parents to psychologically commit to the child, the foster care model used in the study differs from the foster care model used in the United States, which focuses on instrumental care needs, researchers pointed out. Foster parents in the study also received regular support from social workers and psychologists.

The findings “provide strong and conclusive causal evidence that children exposed to early deprivation benefit from high-quality family-based care, and, more broadly, that the nature of the early caregiving environment has an extensive and lasting impact on development,” researchers wrote. “[O]ur findings indicate that providing high-quality and stable family-based care, which includes biological, foster, or adoptive families, is critical for children’s well-being, and, in turn, the well-being of society.”

Reference

King LS, Guyon-Harris KL, Valadez EA, et al. A comprehensive multilevel analysis of the Bucharest Early Intervention Project: causal effects on recovery from early severe depression. Study presented at the American Psychiatric Association Annual Meeting; May 20-24, 2023; San Francisco, CA.