This chapter appears in Child Maltreatment in Residential Care: History, Research, and Current Practice, a volume of research examining the institutionalization of children, child abuse and neglect in residential care, and interventions preventing and responding to violence against children living in out-of-home care settings around the world.
Abstract
The Bucharest Early Intervention Project (BEIP) is the only randomized controlled trial of foster care for children who were abandoned at or shortly after birth and placed into institutional care. The study conducted careful pre-randomization assessments at a mean age of 22 months and has included follow-ups through mid-adolescence. This longitudinal study has provided important insight into the effects of psychosocial deprivation on brain and behavioral development, the importance of sensitive periods, and the ability to recover from severe neglect through high-quality and stable caregiving environments. This chapter reviews the impetus behind the BEIP, as well as key findings related to psychopathology across the longitudinal study. Specifically, early deprivation history is associated with increased risk for psychopathology. In attachment disorder symptomatology, as well as internalizing, externalizing, and attention-deficit/hyperactivity disorder (ADHD) domains, those who had ever experienced institutional care had higher levels of symptoms and/or greater likelihood of meeting diagnostic criteria at the disorder level. Importantly, however, children assigned to the foster care intervention had more positive outcomes in all domains, with the exception of ADHD, in which there was no treatment effect. Secondary analyses indicated important mediators (e.g., attachment security; neural functioning) and moderators (e.g., age of placement; placement stability) of the interventions effect on psychopathology.