Foster Care Better For Cognitive Development Than Institutional Care

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Main Category: Pediatrics / Children's Health
Also Included In: Caregivers / Homecare;  Neurology / Neuroscience;  Psychology / Psychiatry
Article Date: 21 Dec 2007 - 3:00 PST

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A new US study found that abandoned and orphaned young children in Romania raised in foster care showed better cognitive development than those raised in institutions and orphanages.

The randomized controlled trial is published today, 20th December, in the journal Science and is the work of Dr Charles Nelson III, research director of the Developmental Medicine Center at Harvard Medical School and Children's Hospital, Boston, Massachusetts, and colleagues.

Nelson and colleagues compared abandoned children raised in Romanian orphanages or institutions to abandoned children who were first in orphanages and then moved to foster care.

They found that the severe cognitive impairment resulting from profound neglect can be significantly reversed by moving children to foster homes, particularly if this happens before they reach their second birthday. The authors suggest there is a critical period in a child's cognitive development that makes the timing of early intervention crucial.

136 young children less than 31 months of age (average age 22 months) who had been living more or less since birth in 6 orphanages in Bucharest were randomnly assigned to stay in the orphanages (33 male, 35 female) or move to foster care (34 male, 34 female). Their cognitive development was tracked until they were 54 months of age (4.5 years).

There was also a control group of children who had never been institutionalized and who lived with their biological families in Bucharest.

The participants were part of the Bucharest Early Intervention Project (BEIP), the first randomized, controlled trial in the world to examine the effect of foster care on the cognitive, emotional and behavioral damage caused by deprivation in early childhood.

The children's cognitive, motor and behavioural development was assessed at the start of the study, at 30 months, 42 months and 54 months using a range of proven instruments such as the Bayley Scales of Infant Development (BSID) and the Wechsler Preschool Primary Scale of Intelligence (WPPSI).

The data allowed Nelson and colleagues to work out a Developmental Quotient (DQ) for each child, as well as a general intellectual ability (IQ).

The results showed that:

• There were significant differences in scores between the institutional and foster-care groups at 42 months and 54 months.


• This suggested that moving to foster care led to improved cognitive outcomes as assessed by DQ and IQ.


• Birth weight, sex and duration of foster care did not significantly predict DQ or IQ measured at ages 42 or 54 months.


• But age at entry into foster care did significantly predict DQ or IQ measured at ages 42 or 54 months.


• Children placed into foster care earlier had consistently higher DQ scores at 42 months, regardless of how early they were placed.


• But the consistently highest IQ measures at 54 months were for children placed into foster care at 24 to 26 months.

The authors concluded that:

"These results point to the negative sequelae of early institutionalization, suggest a possible sensitive period in cognitive development, and underscore the advantages of family placements for young abandoned children."

Nelson commented that:

"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."

"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," he explained.

Life in orphanages varies somewhat from country to country, said the authors, but regardless of the setting, it is generally highly routinized and regimented, with little exposure to stimulating social activities that help to build language skills for example, and time with care givers is limited.

Nelson and colleagues have been working in this field for some years, and suggest 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".

"Cognitive Recovery in Socially Deprived Young Children: The Bucharest Early Intervention Project."
Charles A. Nelson, III, Charles H. Zeanah, Nathan A. Fox, Peter J. Marshall, Anna T. Smyke, and Donald Guthrie.
Science, 21 December 2007: Vol. 318. no. 5858, pp. 1937 - 1940.
DOI: 10.1126/science.1143921

Click here for Abstract.

Sources: journal Article, Children's Hospital Boston news release.

Written by: Catharine Paddock
Copyright: Medical News Today
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