Alternatives for abandoned children: insights from the Bucharest Early Intervention Project

Current Opinion in Psychology

Volumn 15, Issue , 2017, Pages 182-188

  Zeanah, Charles H ^a   Humphreys, Kathryn L ^b   Fox, Nathan A ^c   Nelson, Charles A ^d,e  

^a TULANE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b STANFORD UNIVERSITY   (United States)

^c UNIVERSITY OF MARYLAND   (United States)

^d BOSTON CHILDREN S HOSPITAL   (United States)

^e HARVARD GRADUATE SCHOOL OF EDUCATION   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 85014312809     PISSN: 2352250X     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.copsyc.2017.02.024     Document Type: Review

References (45)

1. 1 Nelson, C.A., Fox, N.A., Zeanah, C.H., Romania's Abandoned Children: Deprivation, Brain Development and the Struggle for Recovery. 2014, Harvard University Press, Cambridge, MA.
2. 2 Zeanah, C.H., Nelson, C.A., Fox, N.A., Smyke, A.T., Marshall, P., Parker, S.W., Koga, S., Designing research to study the effects of institutionalization on brain and behavioral development: the Bucharest Early Intervention Project. Dev Psychopathol 15 (2003), 885–907.
3. 4 Goldfarb, W., Infant rearing and problem behavior. Am J Orthopsychiatry 13 (1943), 249–265.
4. 5 Goldfarb, W., Infant rearing as a factor in foster home replacement. Am J Orthopsychiatry 14 (1944), 162–173.
5. 6 Goldfarb, W., Effects of psychological deprivation in infancy and subsequent stimulation. Am J Psychiatry 102 (1945), 18–33.
6. 7 Goldfarb, W., Psychological privation in infancy and subsequent adjustment. Am J Orthopsychiatry 15 (1945), 247–255.
7. 8 Levy, R.J., Effects of institutional vs. boarding home care on a group of infants. J Pers 15 (1947), 233–241.
8. 9 Dennis, W., Najarian, P., Infant development under environmental handicap. Psychol Monogr Gen Appl 71 (1957), 1–13.
9. 10 Provence, S., Lipton, R.C., Infants in Institutions. 1962, International Universities Press, New York.
10. 11 Roy, P., Rutter, M., Pickles, A., Institutional care: risk from family background or pattern of rearing. J Child Psychol Psychiatry 41 (2000), 139–141.
11. 12 Harden, B.J., Congregate care for infants and toddlers: shedding new light on an old question. Infant Mental Health J 23 (2002), 476–495.
12. 13 Ahmad, A., Qahar, J., Siddiq, A., Majeed, A., Rasheed, J., Jabar, F., von Knorring, A-l., A 2-year follow-up of orphans’ competence, socioemotional problems and post-traumatic stress symptoms in traditional foster care and orphanages in Iraqi Kurdistan. Child Care Health Dev 31 (2005), 203–215.
13. 14 Rosapepe JC: Half way home: Romania's abandoned children ten years after the revolution. Report of the US Ambassador to Romania; 2005.
14. 15 Zeanah, C.H., Fox, N.A., Nelson, C.A., The Bucharest Early Intervention Project: case study in the ethics of mental health research. J Nerv Mental Dis 200 (2012), 243–247.
15. 16 Zeanah, C.H., Koga, S.F., Simion, B., Stanescu, A., Tabacaru, C.L., Fox, N.A., Nelson, C.A., the BEIP Core Group, Ethical considerations in international research collaboration: the Bucharest Early Intervention Project. Infant Mental Health J 27 (2006), 559–576.
16. 17 Millum, J., Emanuel, E.J., The ethics of international research with abandoned children. Science 318 (2007), 1874–1875.
17. 18 Miller, F.G., The randomized controlled trial as a demonstration project: an ethical perspective. Am J Psychiatry 166 (2009), 743–745.
18. 19 Rid, A., When is research socially valuable? Lessons from the Bucharest Early Intervention Project. J Nerv Mental Dis 200 (2012), 248–249.
19. 20 Smyke, A.T., Zeanah, C.H., Fox, N.A., Nelson, C.A., A new model of foster care for young children: the Bucharest Early Intervention Project. Child Adolesc Psychiatr Clin N Am 18 (2009), 721–734.
20. 21 Larrieu, J., Zeanah, C.H., An intensive intervention for infants and toddlers in foster care. Pruett, K., Pruett, M., (eds.) Custody Child and Adolescent Psychiatric Clinics of North America, 1998, Williams and Wilkins, Philadelphia, 357–371.
21. 22 Smyke, A.T., Dumitrescu, A., Zeanah, C.H., Attachment disturbances in young children: I the continuum of caretaking casualty. J Am Acad Child Adolesc Psychiatry 41 (2002), 972–982.
22. 23 Smyke, A.T., Koga, S.F., Johnson, D.E., Fox, N.A., Marshall, P.J., Nelson, C.A., Zeanah, C.H., the BEIP Core Group, The caregiving context in institution-reared and family-reared infants and toddlers in Romania. J Child Psychol Psychiatry 48 (2007), 210–218.
23. 24 Nelson, C.A., Zeanah, C.H., Fox, N.A., Marshall, P.J., Smyke, A.T., Guthrie, D., Cognitive recovery in socially deprived young children: the Bucharest Early Intervention Project. Science 318 (2007), 1937–1940.
24. 26 Fox, N.A., Almas Degnan, A.N.K.A., Nelson, C.A., Zeanah, C.H., The effects of severe psychosocial deprivation and foster care intervention on cognitive development at 8 years of age: findings from the Bucharest Early Intervention Project. J Child Psychol Psychiatry 52 (2011), 919–928.
25. 27• Almas, A.N., Degnan, K.A., Nelson, C.A., Zeanah, C.H., Fox, N.A., IQ at age 12 following a history of institutional care: findings from the Bucharest Early Intervention Project. Dev Psychol 52 (2016), 1858–1866 This study demonstrates an intervention effect on IQ 8 years after completion of the RCT. 12-year-old children originally randomized to foster care had higher full-scale and verbal IQs than children originally randomized to care as usual. Attachment security at 42 months predicted a profile of stable, typical IQ scores over time.
26. 28 McDermott, J.M., Westerlund, A., Zeanah, C.H., Nelson, C.A., Fox, N.A., Early adversity and neural correlates of executive function: implications for academic adjustment. Dev Cognit Neurosci 2 (2012), S59–S66.
27. 29 Bick, J., Zeanah, C.H., Fox, N.A., Nelson, C.A., Memory and executive functioning in 12-year-old children with histories of institutional rearing. Child Dev, 2017 [in press].
28. 30 Troller-Renfree, S., McDermott, J.M., Nelson, C.A., Zeanah, C.H., Fox, N.A., The effects of early foster care intervention on attention biases in previously institutionalized children in Romania. Dev Sci 18 (2015), 713–722.
29. 31 Troller-Renfree, S., McLaughlin, K.A., Sheridan, M.A., Nelson, C.A., Zeanah, C.H., Fox, N.A., The beneficial effects of a positive attention bias amongst children with a history of psychosocial deprivation. Biol Psychol 122 (2017), 110–120.
30. 32 Almas, A.N., Degnan, K.A., Radulescu, A., Nelson, C.A., Zeanah, C.H., Fox, N.A., Effects of early intervention and the moderating effects of brain activity on institutionalized children's social skills at age 8. Proc Natl Acad Sci U S A 109 (2012), 17228–17231.
31. 33 Almas, A.N., Degnan, K.A., Walker, O.L., Radulescu, A., Nelson, C.A., Zeanah, C.H., Fox, N.A., The effects of early institutionalization and foster care intervention on children's social behaviors at age 8. Soc Dev 24 (2015), 225–239.
32. 34•• Humphreys, K.L., Gleason, M.M., Drury, S.S., Miron, D.M., Nelson, C.A., Fox, N.A., Zeanah, C.H., Effects of institutional rearing and foster care on psychopathology at age 12 years in Romania: follow-up of an open, randomised controlled trial. Lancet Psychiatry 2 (2015), 625–634 Ten years after the study was initiated and eight years after the RCT was completed, boys randomized to foster care rater than care as usual showed significant reductions in signs of externalizing disorders. Children who had remained in their original foster care placements showed significantly fewer signs of internalizing and externalizing disorders. This emphasizes the importance of stability in addition to quality of foster care as an intervention.
33. 35• Humphreys, K.L., McGoron, L., Sheridan, M.A., McLaughlin, K.A., Fox, N.A., Nelson, C.A., Zeanah, C.H., High quality foster care mitigates callous-unemotional traits following severe early deprivation. J Am Acad Child Adolesc Psychiatry 54 (2015), 977–983 At 12 years, boys randomized to foster care showed significantly fewer callous unemotional traits than boys randomized to care as usual. This is the first study to demonstrate that altering early experience can lead to prevention of callous unemotional traits in late childhood.
34. 36 Smyke, A.T., Zeanah, C.H., Gleason, M.M., Drury, S.S., Fox, N.A., Nelson, C.A., Guthrie, D.G., A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder. Am J Psychiatry 169 (2012), 508–514.
35. 37• Humphreys, K.L., Nelson, C.A., Fox, N.A., Zeanah, C.H., Signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years: effects of institutional care history and high-quality foster care. Dev. Psychopathol., 2017 [in press] At age 12 years, children randomized to foster care showed fewer signs of reactive attachment disorder and disinhibited social engagement disorder. This study demonstrates that an early alteration in the caregiving environment leads to longterm reductions in signs of attachment disorders.
36. 38 Sheridan, M.A., Fox, N.A., Zeanah, C.H., McLaughlin, K.A., Nelson, C.A., Variation in neural development as a result of exposure to institutionalization early in childhood. Proc Natl Acad Sci U S A 109 (2012), 12927–12932.
37. 39 Bick, J., Zhu, T., Stamoulis, C., Fox, N.A., Zeanah, C.H., Nelson, C.A., Effect of early institutionalization and foster care on long-term white matter development: a randomized clinical trial. JAMA Pediatr 169 (2015), 211–219.
38. 41• Vanderwert, R., Fox, N.A., Nelson, C.A., Zeanah, C.H., Normalization of EEG activity among previously institutionalized children placed into foster care: a 12-year follow-up of the Bucharest Early Intervention Project. Dev Cognit Neurosci 17 (2016), 68–75 At age 12 years, children originally randomized to foster care showed significantly greater EEG power in the alpha frequency and reduced power in the theta frequency than children randomized to care as usual. Children in stable BEIP placements also showed greater power in the beta frequency. These results indicate that altering early experience enhances brain functioning, especially if quality caregiving is sustained.
39. 42•• McLaughlin, K.A., Sheridan, M.A., Tibu, F., Fox, N.A., Zeanah, C.H., Nelson, C.A., Causal effects of the early caregiving environment on development of stress response systems in children. Acad Sci 112 (2015), 5637–5642 This study demonstrated healthier parasympathetic nervous system and hypothalamic–pituitary axis responses to laboratory stressors at 12 years of age in children randomized to foster care rather than care as usual. The results were explained by children placed prior to 18–24 months of age, underscoring the urgency of early placement of children into adequate caregiving environments.
40. 43 Fox, N.A., Zeanah, C.H., Nelson, C.A., A matter of timing: enhancing positive change for the developing brain. ZERO TO THREE 34 (2014), 4–9.
41. 44 Zeanah, C.H., Gunnar, M.R., McCall, R.B., Kreppner, J.M., Fox, NA, Sensitive periods. McCall, R.B.R.B., van IJzendoorn, M.H., Juffer, F., Groark, C.J., Groza, V.K., (eds.) Children without Permanent Parents: Research, Practice, and Policy, vol. 76, 2011, Wiley, 147–162 Monographs of the Society for Research in Child Development.
42. 45 McGoron, L., Gleason, M.M., Smyke, A.T., Drury, S.D., Nelson, C.A., Gregas, M.C., Fox, N.A., Zeanah, C.H., Recovering from early deprivation: attachment mediates effects of caregiving on psychopathology. J Am Acad Child Adolesc Psychiatry 51 (2012), 683–693.
43. 46 McLaughlin, K.A., Zeanah, C.H., Fox, N.A., Nelson, C.A., Attachment security as a mechanism linking foster care placement to improved mental health outcomes in previously institutionalized children. J Child Psychol Psychiatry 53 (2012), 46–55.
44. 47 Almas, A.N., Degnan, K.A., Walker, O.L., Radulescu, A., Nelson, C.A., Zeanah, C.H., Fox, N.A., The effects of early institutionalization and foster care intervention on children's social behaviors at age 8. Soc Dev 24 (2015), 225–239.
45. 48 Rutter, M., Sonuga-Barke, E.J., Beckett, C., Castle, J., Kreppner, J., Kumsta, R., Stevens, S., Bell, C., Gunnar, M., Deprivation-specific psychological patterns: effects of institutional deprivation. Monogr Res Child Dev 75 (2010), 1–252.