Recovery from Severe Deprivation: The Bucharest Early Intervention Project

Charles H. Zeanah - Journal of the American Academy of Child & Adolescent Psychiatry


Severe early deprivation, as is the case in children who are raised in large impersonal institutions, is associated with increased risks for psychopathology. Less is known about how to remediate children who have experienced social neglect in early childhood. The Bucharest Early Intervention Project (BEIP) is the only randomized, controlled trial of foster care (FC) as an alternative to institutional care ever conducted. The purpose of this presentation is to summarize findings regarding psychopathology and competence through age 12 years.


The BEIP assessed the impacts of institutional care and an FC intervention from infancy through adolescence. A sample group of 136 institutionalized infants and toddlers in Romania between the ages of 6 and 31 months were assigned randomly to either continued care as usual (CAU) or be placed in quality FC. In addition, Romanian children who were never institutionalized were followed to provide a typically developing comparison. The trial continued through 54 months of age. The children have been followed at ages 8, 12, and 16 years.


Previously reported findings included reductions of signs of internalizing disorders and attachment disorders in early childhood and reductions of externalizing disorders and attachment disorders at age 12 years for children who were placed into high-quality FC in early childhood. For children who remained in their original foster placement, signs of internalizing and externalizing disorders were reduced. At 54 months of age, children who would later disrupt their placements were indistinguishable from those who remained stable subsequently on measures of IQ and psychopathology.


Implementation of a quality FC intervention for young children who had experienced severe deprivation proved feasible and led to reduced psychopathology and enhanced competence, compared with children who received CAU. Higher quality of caregiving was provided, and more stable placements reduced the psychopathology in early and middle childhood. A question that remains is whether adolescence represents an opportunity to recover from earlier maladaptation.