Abstract
Background
Experiences in early life lay the foundation for later development and functioning. Severe psychosocial deprivation, as experienced by children in early institutional care, constitutes an adverse experience with long-term negative consequences. The Bucharest Early Intervention Project sought to examine the effects of foster care as an alternative to institutional care for abandoned infants in Romanian institutions.
Methods
At a mean age of 22 months, institutionalized children were randomized to foster care or care as usual. At age 12 years, we followed-up with 98 of these children (50 randomized to foster care), as well as assessed 49 never institutionalized comparison children. Adaptive functioning was assessed across seven domains—mental health, physical health, substance use, risk-taking behavior, family relations, peer relations, and academic performance. Children at or above the threshold for adaptive functioning in at least six of seven domains were classified as having overall adaptive functioning in early adolescence.
Results
Among all children who had experienced severe early deprivation, 40% exhibited adaptive functioning. Children randomized to foster care were significantly more likely to exhibit adaptive functioning at age 12 years than children in the care as usual condition (56% vs. 23%). In support of external validity, children who met the threshold for adaptive functioning at age 12 years had higher IQs and were more physiologically responsive to stress. Among children randomized to foster care, children placed prior to age 20 months were more likely to meet the threshold for adaptive functioning than those placed after this age (79% vs. 46%).
Conclusions
This study provides causal evidence that placing children into families following severe deprivation increases the likelihood of adaptive functioning in early adolescence.