An analysis of data from the Bucharest Early Intervention Project found that children randomly assigned to foster care after experiencing severe early psychosocial deprivation showed better adaptive functioning 16 years later compared to children assigned to foster care as usual. Quality of care mediated the relationship between assigned group and adaptive functioning. The paper was published in developmental psychology.
Children may be assigned to institutional care if their parents are unable to provide safe and appropriate care due to death, abandonment, loss of custody, poverty, illness, disability, neglect, abuse, or family crisis. In residential care, children are placed in residential facilities such as orphanages or group homes, where rotating staff care for many children rather than placing the children in one stable home.
These facilities typically provide food, housing, supervision, and basic medical care, but may have limited warmth and personal attention. Frequent staff turnover and the fact that fewer caregivers care for many children can prevent children from forming secure attachments and reduce opportunities for conversation, play, exploration, and reactive interactions. As a result, children experience emotional, social, cognitive, and sensory deprivation, which can hinder their development.
Tulane University researcher Megan M. Hare and her colleagues analyzed data from the Bucharest Early Intervention Project to examine the potential effects of early exposure to psychosocially depriving institutional care on adaptive functioning during the transition to adulthood and compare them to the effects of high-quality foster care. They also wanted to know whether the quality of care during adolescence mediated the association between the type of care a child was assigned and adaptive functioning at age 18.
The Bucharest Early Intervention Project was a groundbreaking study that investigated how institutional care and foster care placement affect the development of abandoned children in Romania. The scheme started in 2000 and 2001 and involved 136 children living in six facilities in Bucharest, with an average age of approximately 22 months at the time of enrollment.
After a baseline assessment, the children were randomly assigned to receive either regular care, usually long-term institutional care, or a specially designed, high-quality foster care program. The third comparison group consisted of children from the local community who had never lived in an institution. Researchers assessed cognitive abilities, language, attachment, emotional and behavioral problems, physical growth, brain activity, and several other developmental outcomes.
The analysis for this study included 93 of the original 136 children. Of these, 46 were in the care-as-usual group and 47 were in the group assigned to foster care. There were also 41 children in the control group who were not institutionalized. At the time of this analysis, the average age of the participants was approximately 19 years. Approximately 61% identify as Romanian and 20% as Roma, while 19% have no identified ethnic identity.
Participants completed an assessment of adaptive functioning, which refers to the practical skills individuals need to live independently, such as self-care, communication, and interpersonal skills. The researchers also collected staff ratings of the quality of care the children received when they were 12 and 16 years old. Two members of the research staff who were familiar with the children’s families independently provided these assessments.
Results showed that 16 years after being assigned to foster care or regular care, participants who grew up in foster care achieved significantly higher adaptive functioning scores, particularly in the areas of communication and socialization skills. These findings hold true even when adaptive functions are expressed at comparable ages. For example, the mean age-equivalent level for the usual care group was 12.5 years, compared to 15.2 years for the foster care group. However, both groups lagged significantly behind the noninstitutionalized group.
Further analyzes revealed that child care quality significantly mediated the association between the type of care children were assigned and their adaptive functioning. Similarly, comparisons with a group of children who had never been institutionalized revealed that quality of care mediated the association between caregiving environment and adaptive functioning.
“These findings highlight the positive influence of the nurturing environment on children’s adaptive functioning and show that early investment in family care as an alternative to institutional care leads to improved adaptive functioning during the transition to adulthood,” the study authors concluded.
This study reveals the importance of caregiving arrangements in children’s psychosocial development. However, it is important to note that institutional and foster care may be provided at different levels of quality and may provide very different opportunities for children to form secure attachments with their caregivers. The results of studies examining different institutional care and foster care arrangements under different conditions may not be identical.
The paper, “Adaptive functioning at age 18 after severe early deprivation: Results from a randomized controlled trial,” was authored by Megan M. Hare, Kathryn L. Humphreys, Anna Kosmoiu, Nathan A. Fox, Charles A. Nelson, and Charles H. Zeana.
