Institutionalized children recover cognitive function when placed in foster care
December 20, 2007
A study of Romanian children abandoned to institutions at birth demonstrates that the severe cognitive impairment that results from profound neglect can be significantly reversed through placing children in foster-home settings, particularly if placed before age 2. The study, led by Charles A. Nelson, PhD, research director of the Developmental Medicine Center at Children's Hospital Boston and professor of Pediatrics at Harvard Medical School, suggests that there is a sensitive period in cognitive development, making early intervention crucial.
Published in the December 21 issue of the journal Science, these findings are the latest to come out of the Bucharest Early Intervention Project (BEIP) -- the first randomized, controlled trial in the world to investigate whether foster care can heal the cognitive, emotional and behavioral wounds of severe early childhood deprivation.
Although they vary both within and between countries, institutional settings are often characterized by highly regimented routines; provide little or no exposure to normal language or activities that stimulate the senses; and offer limited access to caregivers. Over the past seven years, Nelson's team has documented that institutionalized children often suffer from a variety of neurobiological and behavioral challenges, as compared to children who have never been institutionalized. In this study, Nelson and his team look specifically at the issue of cognitive delay brought about by this early deprivation.
Study participants comprised 136 children less than 31 months of age (average age 22 months) and residing in any of six institutions for young abandoned children in Bucharest, Romania. Following an initial assessment, 68 children (33 male, 35 female) were randomly assigned to remain in institutional care, while the other 68 (34 male, 34 female) were randomly assigned to foster care. A third group of never institutionalized children, residing with their biological families in the greater Bucharest community, served as the comparison group.
Cognitive development was assessed at baseline, 30 months and 42 months with the Bayley Scales of Infant Development (BSID), and at 54 months with the Wechsler Preschool Primary Scale of Intelligence (WPPSI). The BSID measures a child's level of development in three areas: cognitive, motor and behavioral. Using this data, the researchers calculated a Developmental Quotient (DQ) for each child. The WPPSI consists of 14 subtests that assess intellectual functioning in verbal and performance domains, as well as a child's general intellectual ability (IQ).
The researchers reported significant differences between the institutional and foster-care groups at 42 months and 54 months, suggesting that foster care intervention led to improved cognitive outcomes as assessed by DQ and IQ. According to Nelson, "this finding clearly indicates the efficacy of our intervention in ameliorating the cognitive decline associated with early institutionalization."
Going one step further, the researchers looked at other factors that could explain the difference in outcome. While birth weight, sex and duration of time in foster care did not significantly predict DQ or IQ measured at ages 42 or 54 months, age at entry into foster care was an important predictor. The researchers compared DQ/IQ scores for children who entered foster care at different age cutoffs. Children placed earlier consistently had higher DQ scores 42 months, regardless of the specific ages cutoff used. However, for IQ measured at 54 months, the greatest difference was seen when the cutoff was set at 24 to 26 months.
"Differences at 42 and 54 months were attributed to differences in test instrument, and not to any change in IQ across that age span," explains Nelson.
"At first glance, our findings suggest there may be a sensitive period spanning the first two years of life within which the onset of foster care exerts a maximal effect on cognitive development," he adds. "However, a closer reading of our analyses suggests a more prudent conclusion -- that the younger a child is when placed in foster care, the better the outcome."
Nelson reminds us however, that even among the youngest children placed in foster care, children with histories of institutionalization still have IQs that are nearly 10 points below that of never institutionalized children.
This study was funded by the John D. and Catherine T. MacArthur Foundation's Research Network on Early Experience and Brain Development.
Children's Hospital Boston is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 500 scientists, including eight members of the National Academy of Sciences, 11 members of the Institute of Medicine and 12 members of the Howard Hughes Medical Institute comprise Children's research community. Founded as a 20-bed hospital for children, Children's Hospital Boston today is a 377-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children's also is the primary pediatric teaching affiliate of Harvard Medical School. For more information about the hospital and its research visit: www.childrenshospital.org/newsroom.
Charles A. Nelson, PhD