Severe early deprivation leaves lasting mark on life skills 16 years later

An analysis of the Bucharest Early Intervention Project data found that children who were randomly assigned to foster care after severe early psychosocial deprivation showed better adaptive functioning 16 years later compared to those who were assigned to care as usual. Caregiving quality mediated the relationship between the assigned group and adaptive functioning. The paper was published in Developmental Psychology.

When parents die, abandon their children, lose custody, or are unable to provide safe and adequate care because of poverty, illness, disability, neglect, abuse, or family crisis, children may get assigned to institutional care. Institutional care places children in residential facilities, such as orphanages or group homes, where rotating staff care for many children instead of children being in one stable family.

Although these facilities usually provide food, shelter, supervision, and basic medical care, they may offer limited emotional warmth and individualized attention. Frequent staff changes and the fact that a small number of caregivers look after many children can prevent children from forming secure attachments and reduce opportunities for conversation, play, exploration, and responsive interaction. As a result, children may experience emotional, social, cognitive, and sensory deprivation that can interfere with their development.

Megan M. Hare, a researcher at Tulane University, and colleagues analyzed data from the Bucharest Early Intervention Project aiming to examine the potential influence of early exposure to psychosocially depriving institutional care on adaptive functioning during the transition to adulthood and compare it to the consequences of high-quality foster care. They also wanted to know whether caregiving quality in adolescence mediated the association between the type of care children were assigned to and adaptive functioning at 18 years of age.

The Bucharest Early Intervention Project was a landmark study examining how institutional care and foster placement affect the development of abandoned children in Romania. It began in 2000 and 2001 and included 136 children living in six institutions in Bucharest, whose average age at enrollment was about 22 months.

After baseline assessments, eligible children were randomly assigned either to receive care as usual, which generally involved longer placements in institutional care, or to enter a specially created, high-quality foster-care program. A third comparison group consisted of children from the local community who had never lived in institutions. The researchers assessed cognitive ability, language, attachment, emotional and behavioral problems, physical growth, brain activity, and several other developmental outcomes.

The analysis in this study included 93 of the original 136 children. Of these, 46 were in the care-as-usual group and 47 were from the group assigned to foster care. There were also 41 children from the control group that were never institutionalized. At the time of this analysis, participants’ average age was nearly 19 years old. About 61% identified as Romanian and 20% identified as Roma, while the ethnic identity of 19% was not specified.

Participants completed an assessment of adaptive functioning, meaning the practical skills individuals need for independent living, such as self-care, communication, and interpersonal skills. The researchers also collected staff ratings of the caregiving quality the children received at age 12 and 16. Two members of the study staff familiar with the child’s family independently provided these ratings.

Results showed that, 16 years after being assigned to foster care or care as usual, participants who grew up in foster care achieved significantly higher adaptive functioning scores, particularly in the areas of communication and socialization skills. These findings held when adaptive functioning was represented in age equivalences. For example, those in the care-as-usual group functioned, on average, at an age-equivalent level of 12.5 years, compared to 15.2 years for the foster care group. However, both groups lagged significantly behind the never-institutionalized group.

Further analyses revealed that caregiving quality significantly mediated the link between the type of care the children were assigned to and their adaptive functioning. Comparison with the group of children who were never institutionalized similarly revealed that caregiving quality mediated the link between the caregiving setup and adaptive functioning.

“These findings underscore the positive impact of nurturing environments on children’s adaptive functioning and indicate that early investment in family care as an alternative to institutional care leads to better adaptive functioning during the transition to adulthood,” the study authors concluded.

The study sheds light on the importance of caregiving arrangements for children’s psychosocial development. However, it should be noted that both institutional care and foster care can be provided with different levels of quality and may substantially differ in the opportunities they provide children to form secure attachments to caregivers. Findings of studies that examine different institutional care systems and foster care arrangements in different conditions may not be identical.

The paper, “Adaptive Functioning at Age 18 Years Following Severe Early Deprivation: Results of a Randomized Controlled Trial,” was authored by Megan M. Hare, Kathryn L. Humphreys, Ana Cosmoiu, Nathan A. Fox, Charles A. Nelson, and Charles H. Zeanah.