Alternatives for abandoned children: Insights from the Bucharest Early Intervention Project
Open accessAbstract
The Bucharest Early Intervention Project is the first and only randomized controlled trial of foster care as an alternative to institutional care for orphaned and abandoned children. Across various domains of brain and behavioral development we demonstrated that children in families developed more favorably than children in institutions, that foster care remediates some but not all compromises associated with institutional placement and that earlier placement in foster care leads to more developmental gains in some but not all domains. In addition to early placement, higher quality of care provided and more stable placements for children all enhanced outcomes. These results have important implications for science, practice and policy.
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- Findingown data
Cortical white matter volume partially mediated the effect of institutional rearing on EEG alpha power.
“Further, cortical white matter volume partially mediated the effect of institutional rearing on EEG alpha power, suggesting that reductions in circuitry were associated with reductions in brain electrical activity.”
Quote in the paperNot a substantial claim - Findingcitation
Quality of caregiving, objectively coded from videotaped observations, was higher in BEIP foster care than in care as usual.
“Quality of caregiving, which was objectively coded from videotaped observations, was higher in the children in BEIP foster care than children who received care as usual [1].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] Nelson CA Fox NA Zeanah CH Romania’s abandoned children: Deprivation, brain development and the struggle for recovery Cambridge, MA Harvard University Press 2014
Not checked in the free run.
- Findingcitation
Children randomized to foster care showed healthier stress responses, as measured by cortisol and autonomic nervous system indices.
“Children randomized to foster care demonstrated healthier stress responses, as indexed both by cortisol levels and autonomic nervous system indices [42].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [42] source
Not checked in the free run.
- Findingcitation
At baseline, children later randomized to foster care and care as usual did not differ.
“At baseline, there were no differences between the children later randomized to foster care or care as usual”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [1] Nelson CA Fox NA Zeanah CH Romania’s abandoned children: Deprivation, brain development and the struggle for recovery Cambridge, MA Harvard University Press 2014
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [23] Smyke AT Koga SF Johnson DE Fox NA Marshall PJ Nelson CA Zeanah CH the BEIP Core Group The caregiving context in institution-reared and family-reared infants and toddlers in Romania Journal of Child Psychology and Psychiatry 2007 48 210 218 17300560 source
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- Findingcitation
At baseline, institutionalized children differed from never-institutionalized children in nearly every developmental domain.
“but these children living in institutions were different from their never institutionalized counterparts in virtually every developmental domain [1,23].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [1] Nelson CA Fox NA Zeanah CH Romania’s abandoned children: Deprivation, brain development and the struggle for recovery Cambridge, MA Harvard University Press 2014
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [23] Smyke AT Koga SF Johnson DE Fox NA Marshall PJ Nelson CA Zeanah CH the BEIP Core Group The caregiving context in institution-reared and family-reared infants and toddlers in Romania Journal of Child Psychology and Psychiatry 2007 48 210 218 17300560 source
Not checked in the free run.
- Findingcitation
Foster care children had significantly higher IQs than care-as-usual children over time.
“Although IQs of FCG children were significantly higher than those CAUG children over time [26, 27]”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [26] Fox NA Almas AN Degnan KA Nelson CA Zeanah CH 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 Journal of Child Psychology and Psychiatry 2011 52 919 928 21244422 PMC4088941 source
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- cites [27] source
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- Findingown data
As a group, foster care children most often functioned at a level between care-as-usual children and never-institutionalized children.
“Most often the FCG children, as a group, occupy a level of functioning that is intermediate to the CAUG and NIG.”
Quote in the paperSubstantial claim - Findingcitation
Brain structure and functioning at ages 8 and 12 were enhanced by the intervention.
“Brain structure and functioning at 8 and 12 years also were enhanced by the intervention [38–41].”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [38] Sheridan MA Fox NA Zeanah CH McLaughlin KA Nelson CA Variation in neural development as a result of exposure to institutionalization early in childhood Proceedings of the National Academy of Sciences 2012 109 12927 12932 PMC3420193 22826224 source
Not checked in the free run.
- cites [39] Bick J Zhu T Stamoulis C Fox NA Zeanah CH Nelson CA Effect of early institutionalization and foster care on long-term white matter development: a randomized clinical trial JAMA Pediatrics 2015 169 211 219 25622303 PMC4413892 source
Not checked in the free run.
- cites [40] Vanderwert RE Marshall PJ Nelson CA Zeanah CH Fox NA Timing of intervention affects brain electrical activity in children exposed to severe psychosocial neglect PLoS ONE 2010 5 1 5 PMC2895657 20617175 source
Not checked in the free run.
- cites [41]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
Foster care children showed an attention bias toward positive facial expressions at ages 8 and 12.
“FCG children also demonstrated an attention bias to positive facial expressions of emotion at both 8 and 12 years [30, 31].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [30] Troller-Renfree S McDermott JM Nelson CA Zeanah CH Fox NA The effects of early foster care intervention on attention biases in previously institutionalized children in Romania Developmental Science 2015 18 713 722 25439678 PMC4447605 source
Not checked in the free run.
- cites [31] Troller-Renfree S McLaughlin KA Sheridan MA Nelson CA Zeanah CH Fox NA The beneficial effects of a positive attention bias amongst children with a history of psychosocial deprivation Biological Psychology 2017 122 110 120 27109625 PMC5074922 source
Not checked in the free run.
- Findingcitation
During naturalistic interactions at 30 months, caregiving quality predicted early psychopathology.
“During naturalistic interactions at 30 months, quality of caregiving was an important predictor of early psychopathology [45].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [45] McGoron L Gleason MM Smyke AT Drury SD Nelson CA Gregas MC Fox NA Zeanah CH Recovering from early deprivation: Attachment mediates effects of caregiving on psychopathology Journal of the American Academy of Child and Adolescent Psychiatry 2012 51 683 693 22721591 PMC4127424 source
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- Findingown data
Across most developmental domains, children in foster care developed more favorably than children receiving care as usual.
“Results from the RCT were consistent across most developmental domains -- children in foster care developed more favorably than children who received care as usual.”
Quote in the paperSubstantial claim - Findingcitation
There were few intervention effects on executive functioning skills.
“there were few intervention effects on executive functioning skills [28, 29], which were not assessed in early childhood.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [28] McDermott JM Westerlund A Zeanah CH Nelson CA Fox NA Early adversity and neural correlates of executive function: Implications for academic adjustment Developmental Cognitive Neuroscience 2012 2 S59 S66 22682911 PMC3408020 source
Not checked in the free run.
- cites [29] Bick J Zeanah CH Fox NA Nelson CA Memory and executive functioning in 12-year-old children with histories of institutional rearing Child Development in press PMC5847423 28898388 source
Not checked in the free run.
- Findingown data
For some but not all domains, children placed in foster care at younger ages fared better than those placed at older ages.
“For some, but clearly not all domains, children placed into foster care at earlier ages fared better than those placed at older ages.”
Quote in the paperSubstantial claim - Findingcitation
White matter tracts in the external capsule and corpus callosum partially explained the link between institutional rearing and internalizing symptoms in middle childhood and early adolescence.
“Also, white matter tracts in the external capsule and corpus callosum partially explained links between institutional rearing status and internalizing symptoms in middle childhood and early adolescence [39].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [39] Bick J Zhu T Stamoulis C Fox NA Zeanah CH Nelson CA Effect of early institutionalization and foster care on long-term white matter development: a randomized clinical trial JAMA Pediatrics 2015 169 211 219 25622303 PMC4413892 source
Not checked in the free run.
- Findingcitation
Social behaviors, including peer relations and social skills, were enhanced in foster care children.
“Social behaviors, including peer relations and social skills were enhanced [32, 33].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [32] Almas AN Degnan KA Radulescu A Nelson CA Zeanah CH Fox NA Effects of early intervention and the moderating effects of brain activity on institutionalized children’s social skills at age 8 Proceedings of the National Academy of Sciences 2012 109 17228 17231 PMC3477393 23045660 source
Not checked in the free run.
- cites [33] Almas AN Degnan KA Walker OL Radulescu A Nelson CA Zeanah CH Fox NA The effects of early institutionalization and foster care intervention on children’s social behaviors at age 8 Social Development 2015 24 225 239 26294847 PMC4539259 source
Not checked in the free run.
- Findingown data
IQ differences between foster care children and never-institutionalized children were large at all time points examined.
“For example, the magnitude of IQ differences between the FCG and NIG were large across all time points considered.”
Quote in the paperSubstantial claim - Findingcitation
Secure attachment in early childhood predicted IQ and peer relations at age 8.
“In fact, secure attachment in early childhood also predicted other subsequent outcomes, including IQ and peer relations at 8 years [26, 47].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [26] Fox NA Almas AN Degnan KA Nelson CA Zeanah CH 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 Journal of Child Psychology and Psychiatry 2011 52 919 928 21244422 PMC4088941 source
Not checked in the free run.
- cites [47] Almas AN Degnan KA Walker OL Radulescu A Nelson CA Zeanah CH Fox NA The effects of early institutionalization and foster care intervention on children’s social behaviors at age 8 Social Development 2015 24 225 239 26294847 PMC4539259 source
Not checked in the free run.
- Findingcitation
At age 12, children who had remained in a stable foster placement since randomization were less likely to show internalizing and externalizing disorders.
“At age 12 years, children who had remained in a stable foster placement since original randomization were less likely to display signs of internalizing and externalizing disorders [34]”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34] source
Not checked in the free run.
- Findingcitation
At age 12, children in stable foster placements were more likely to show an attention bias to positive emotional displays.
“as well as more likely to demonstrate an attention bias to positive emotional displays”
Quote in the paperSubstantial claim - Findingown data
There were no differences on multiple earlier measures between children whose placements later disrupted and those whose placements did not.
“but we found no differences on multiple measures at earlier ages in children whose placements subsequently disrupted and those that did not”
Quote in the paperSubstantial claim - Findingnone given
Cognitive development and psychopathology showed the least response to quality foster care intervention.
“the effects on cognitive development and psychopathology showed the least response to quality foster care intervention.”
Quote in the paperSubstantial claim - Findingown data
Early institutional rearing was associated with large harmful effects across physical, cognitive, socioemotional, and behavioral domains.
“Though early institutional rearing was associated with large deleterious effects across physical, cognitive, socioemotional and behavioral domains”
Quote in the paperSubstantial claim - Findingown data
Instability in foster care placement was related to threat bias.
“while instability of foster care placement was related to threat bias.”
Quote in the paperSubstantial claim - Interpretationreasoning
The care provided by foster parents would be the main route for addressing the children's developmental delays and deviant behavior.
“Therefore, we knew that the care that foster parents provided would be the major means through which children’s developmental delays and deviant behavior would be addressed.”
Quote in the paperSubstantial claim- Rests on an assumption: Resources for special needs children were not widely available in Romania at that time.
- Interpretationown data
The timing results are compatible with sensitive periods in brain development.
“We have considered these results as compatible with sensitive periods in brain development [1, 43, 44].”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [1] Nelson CA Fox NA Zeanah CH Romania’s abandoned children: Deprivation, brain development and the struggle for recovery Cambridge, MA Harvard University Press 2014
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [43] Fox NA Zeanah CH Nelson CA A matter of timing: Enhancing positive change for the developing brain Journal of Zero to Three: National Center for Infants, Toddlers and Families 2014 34 4 9
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [44] Zeanah CH Gunnar MR McCall RB Kreppner JM Fox NA Sensitive periods. Children without permanent parents: Research, practice, and policy McCall RB van IJzendoorn MH Juffer F Groark CJ Groza VK Monographs of the Society for Research in Child Development 2011 76 147 162 PMC4130246 25125708 source
Not checked in the free run.
- Interpretationreasoning
The randomized design was the only one that could yield definitive evidence about which care form was better.
“Thus, this was the only design that could provide definitive evidence of which form of care was preferable [1,2].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [1] Nelson CA Fox NA Zeanah CH Romania’s abandoned children: Deprivation, brain development and the struggle for recovery Cambridge, MA Harvard University Press 2014
Not checked in the free run.
- cites [2] Zeanah CH Nelson CA Fox NA Smyke AT Marshall P Parker SW Koga S Designing research to study the effects of institutionalization on brain and behavioral development: The Bucharest Early Intervention Project Development and Psychopathology 2003 15 885 907 14984131 source
Not checked in the free run.
- Study design and conductreasoning
The study enrolled vulnerable children only because the research question was relevant to them.
“Briefly, we conducted a study with a vulnerable population only because it addressed a question relevant to them.”
Quote in the paperNot a substantial claim - Premisecitation
Prior to BEIP, few descriptive studies-mainly from the mid-1900s-had contrasted foster care with institutional care.
“Prior to the study this paper describes, only a small number of descriptive studies, mostly conducted in the mid-20th century, had compared children in foster care to children in institutional care (4–13).”
Quote in the paperSubstantial claim0 of 10 sources checked- cites [4] Goldfarb W Infant rearing and problem behavior American Journal of Orthopsychiatry 1943 13 249 265
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [5] Goldfarb W Infant rearing as a factor in foster home replacement American Journal of Orthopsychiatry 1944 14 162 173
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [6] Goldfarb W Effects of psychological deprivation in infancy and subsequent stimulation American Journal of Psychiatry 1945 102 18 33 source
Not checked in the free run.
- cites [7] Goldfarb W Psychological privation in infancy and subsequent adjustment American Journal of Orthopsychiatry 1945 15 247 255
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [8] Levy RJ Effects of institutional vs. boarding home care on a group of infants Journal of Personality 1947 15 233 241
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [9] Dennis W Najarian P Infant development under environmental handicap Psychological Monographs: General and Applied 1957 71 1 13
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [10] Provence S Lipton RC Infants in institutions New York International Universities Press 1962
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [11] Roy P Rutter M Pickles A Institutional care: Risk from family background or pattern of rearing? Journal of Child Psychology and Psychiatry 2000 41 139 141 10750540 source
Not checked in the free run.
- cites [12] Harden BJ Congregate care for infants and toddlers: Shedding new light on an old question Infant Mental Health Journal 2002 23 476 495
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [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 and Development 2005 31 203 215 15715699 source
Not checked in the free run.
- Premisecitation
Those earlier descriptive studies reported that foster care children fared better developmentally than institutionalized children.
“Results demonstrated that children in foster care developed more favorably than children in institutions.”
Quote in the paperSubstantial claim0 of 10 sources checked- cites [4] Goldfarb W Infant rearing and problem behavior American Journal of Orthopsychiatry 1943 13 249 265
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [5] Goldfarb W Infant rearing as a factor in foster home replacement American Journal of Orthopsychiatry 1944 14 162 173
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [6] Goldfarb W Effects of psychological deprivation in infancy and subsequent stimulation American Journal of Psychiatry 1945 102 18 33 source
Not checked in the free run.
- cites [7] Goldfarb W Psychological privation in infancy and subsequent adjustment American Journal of Orthopsychiatry 1945 15 247 255
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [8] Levy RJ Effects of institutional vs. boarding home care on a group of infants Journal of Personality 1947 15 233 241
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [9] Dennis W Najarian P Infant development under environmental handicap Psychological Monographs: General and Applied 1957 71 1 13
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [10] Provence S Lipton RC Infants in institutions New York International Universities Press 1962
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [11] Roy P Rutter M Pickles A Institutional care: Risk from family background or pattern of rearing? Journal of Child Psychology and Psychiatry 2000 41 139 141 10750540 source
Not checked in the free run.
- cites [12] Harden BJ Congregate care for infants and toddlers: Shedding new light on an old question Infant Mental Health Journal 2002 23 476 495
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [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 and Development 2005 31 203 215 15715699 source
Not checked in the free run.
- Premisereasoning
Adoption studies are constrained by possible selection bias.
“but they are limited by the potential for selection bias inherent in adoption.”
Quote in the paperSubstantial claim - Interpretationreasoning
Because the design was randomized, the results are definitive proof that foster care placement improved functioning.
“Because of the randomized design, these results are definitive proof that foster care placement led to enhanced functioning.”
Quote in the paperSubstantial claim - Premisecitation
Young children in the institutions had serious developmental delays and deviances, as known from informal observations and pilot assessments.
“We knew from informal observations and pilot assessments [22] that these young children had serious developmental delays and deviances”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22] Smyke AT Dumitrescu A Zeanah CH Attachment disturbances in young children: I The continuum of caretaking casualty Journal of the American Academy of Child and Adolescent Psychiatry 2002 41 972 982 12162633 source
Not checked in the free run.
- Premisecitation
Adoption of institutionalized Romanian infants before 6 months of age led to near complete recovery across domains.
“The urgency of early family placements is underscored by others’ findings that adoption of institutionalized Romanian infants before 6 months of age in led to near complete recovery across domains [48].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [48] Rutter M Sonuga-Barke EJ Beckett C Castle J Kreppner J Kumsta R Stevens S Bell C Gunnar M Deprivation-specific psychological patterns: Effects of institutional deprivation Monographs of Research in Child Development 2010 75 1 252 20500633
Not checked in the free run.
- Interpretationown data
It is unlikely that challenging behaviors caused the placement disruptions.
“so it is unlikely that challenging behaviors led to the disruptions.”
Quote in the paperSubstantial claim - Interpretationreasoning
Developmental delays and deviance caused by deprivation appear not to be transient.
“Given that developmental delays and deviance from deprivation seem not to be transient, sustained investments in high quality care are worth pursuing and sustaining.”
Quote in the paperSubstantial claim
- May combine two claims. 12
- Classified as probably not a substantial claim. 5
May combine two claims.
FindingcitationAt age 12, externalizing signs, callous-unemotional traits, and attachment disorder behaviors were reduced for children in foster care.
“Externalizing signs, CU traits and attachment disorder behaviors at 12 years all were reduced for children living in foster care [34–37].”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [34] source
Not checked in the free run.
- cites [35] source
Not checked in the free run.
- cites [36] Smyke AT Zeanah CH Gleason MM Drury SS Fox NA Nelson CA Guthrie DG A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder American Journal of Psychiatry 2012 169 508 514 22764361 PMC4158103 source
Not checked in the free run.
- cites [37] source
Not checked in the free run.
May combine two claims.
FindingcitationSecure attachments at 42 months were significantly more likely in foster care and mediated the effect of caregiving quality on psychopathology at 54 months.
“Secure attachments at 42 months, which were significantly more likely in children in foster care, mediated the effect of caregiving quality on psychopathology at 54 months [46].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [46] McLaughlin KA Zeanah CH Fox NA Nelson CA Attachment security as a mechanism linking foster care placement to improved mental health outcomes in previously institutionalized children Journal of Child Psychology & Psychiatry 2012 53 46 55 21733136 PMC3193871
Not checked in the free run.
May combine two claims.
Findingown dataThe ages at which timing differences became significant ranged from 12 to 24 months, with most between 20 and 24 months.
“The ages at which differences became significant ranged from 12–24 months, but most were between 20 and 24 months of age.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe overall intervention effects were consistently small to medium in magnitude and all in the expected direction.
“Overall, the magnitude of the effects illustrated in Table 2a are consistently in the small to medium range (all in the expected direction, FCG have better outcomes than CAUG).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataWhen foster care children were compared with never-institutionalized children, effect sizes varied greatly; some domains showed almost complete catch-up, such as height, weight, and EEG alpha power, while others did not.
“Here, effect sizes vary dramatically, with some domains showing almost complete catch-up (e.g., height, weight, EEG alpha power) and others demonstrating a lack of complete catch-up despite notable difference between those children who did and did not get assigned to the intervention.”
Quote in the paperSubstantial claimMay combine two claims.
FindingcitationThe magnitude of positive attention bias was associated with fewer internalizing problems and better coping mechanisms.
“The magnitude of the positive bias was associated with fewer internalizing problems and better coping mechanisms [31].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [31] Troller-Renfree S McLaughlin KA Sheridan MA Nelson CA Zeanah CH Fox NA The beneficial effects of a positive attention bias amongst children with a history of psychosocial deprivation Biological Psychology 2017 122 110 120 27109625 PMC5074922 source
Not checked in the free run.
May combine two claims.
Findingnone givenThe lack of sustained and meaningful support to the foster care program after the trial ended was accompanied by more disrupted placements and loss of some developmental and clinical gains.
“From a practice and policy perspective, the lack of sustained and meaningful support to the foster care program at the trial’s conclusion was accompanied by an increase in disrupted placements and loss of some developmental and clinical gains.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataEarlier placement into foster care, higher quality of care, and more stable placements all enhanced outcomes.
“Earlier placement into foster care, higher quality of care provided, and more stable placements all enhanced outcomes.”
Quote in the paperSubstantial claimMay combine two claims.
FindingreasoningPlacement disruptions often resulted from decisions to reunify children with their biological families, sometimes followed by later returns to institutional care.
“Instead, the disruptions often resulted from decisions to reunify children with their biological families, sometimes with subsequent later returns to institutional care.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenOnly measures carrying no more than minimal risk to participants were used.
“Third, we used only measures that posed no more than minimal risk to participants.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductreasoningRandomizing infants who were already in institutions makes the groups comparable on pre-existing risk factors, so outcome differences can be attributed to the intervention.
“The unique and crucial advantage of randomizing infants already living in institutions is that both groups share pre-existing risk factors, and any differences in outcomes can be confidently attributed to the intervention.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisereasoningA difficulty in interpreting those earlier comparisons is that children with greater handicaps may have been more likely to enter institutions than foster care.
“On the other hand, interpreting these results is challenging, given that it is plausible that more handicapped children might be more likely to be placed in institutions rather than foster care.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe study had multiple oversight levels within Romania and at each principal investigator's university.
“Fourth, there were multiple levels of oversight of the study within Romania and at each principal investigator’s university.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Interpretationnone givenThe foster care program was culturally appropriate, feasible, replicable, and informed by developmental science.
“We endeavored to create a foster care program in Bucharest that was culturally appropriate, feasible, replicable and informed by developmental science.”
Quote in the paperNot a substantial claim- Rests on an assumption: Resources for special needs children were not widely available in Romania at that time.
- Rests on an assumption: The child protection system in Bucharest was overwhelmed and underfunded at the time.
- Rests on an assumption: The social work profession in Romania was inexperienced because Ceausescu eliminated social work as a profession.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningThe investigators did not intervene in decisions about changing children's placements, because Romanian child protection officials held legal authority over those decisions.
“Second, we did not interfere in any decisions about changes in placement of the children since legally those decisions had to be made by Romania’s child protection officials.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataImplementing quality foster care for young children who had experienced severe deprivation was feasible and improved developmental outcomes across many domains compared with care as usual.
“Implementation of a quality foster care intervention for young children who had experienced severe deprivation proved feasible and led to improved developmental outcomes across numerous domains compared to care as usual.”
Quote in the paperSubstantial claim
The paper relies on this without support.
The Bucharest Early Intervention Project is the first and only randomized controlled trial of foster care as an alternative to institutional care for orphaned and abandoned children.
“The Bucharest Early Intervention Project is the first and only randomized controlled trial of foster care as an alternative to institutional care for orphaned and abandoned children.”
The paper relies on this without support.
Resources for special needs children were not widely available in Romania at that time.
“We also knew that resources for special needs children were not widely available at that time in Romania.”
The paper relies on this without support.
The child protection system in Bucharest was overwhelmed and underfunded at the time.
“not only was the fledging child protection system in Bucharest overwhelmed and underfunded at the time”
The paper relies on this without support.
The social work profession in Romania was inexperienced because Ceausescu eliminated social work as a profession.
“the entire profession of social work in Romania was inexperienced due to Ceausescu’s elimination of social work as a profession (deeming it unnecessary).”
The paper relies on this without support.
Millions of orphaned, abandoned, and maltreated children worldwide require care that cannot be provided by their parents or families.
“Millions of orphaned, abandoned, and maltreated children worldwide require care that cannot be provided by their parents or families.”
The paper relies on this without support.
More recent studies of children adopted from institutions show substantial gains after family placement.
“More recent studies of children adopted from institutions similarly show substantial gains after family placement”
The paper relies on this without support.
Most adoption studies did not assess children within institutions before adoption.
“In addition, most did not assess the children within the institutions prior to adoption.”
The paper relies on this without support.
The measures planned for the study had not been used in Romania before.
“since the measures we planned to use had not been used in Romania before”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The authors' prior work has shown timing effects for certain outcomes.
“While we too have shown timing effects for certain outcomes (39)”
From Long-term effects of institutional rearing, foster care, and brain activity on memory and executive functioning (2019) · cites this paper as [39]
Cites
Cognitive Recovery in Socially Deprived Young Children: The Bucharest Early Intervention Project
Nelson, C. A., Zeanah, C. H., Fox, N. A., Marshall, P. J., Smyke, A. T., & Guthrie, D. (2007) · Science · doi:10.1126/science.1143921 · Cited by 951 · see citing works
Self-citationZEANAH, C. H., NELSON, C. A., FOX, N. A., SMYKE, A. T., MARSHALL, P., PARKER, S. W., & KOGA, S. (2003) · Development and Psychopathology · doi:10.1017/s0954579403000452 · Cited by 447 · see citing works
Self-citationVariation in neural development as a result of exposure to institutionalization early in childhood
Sheridan, M. A., Fox, N. A., Zeanah, C. H., McLaughlin, K. A., & Nelson, C. A. (2012) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1200041109 · Cited by 432 · see citing works
Self-citationMcLaughlin, K. A., Sheridan, M. A., Tibu, F., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2015) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1423363112 · Cited by 426 · see citing works
Self-citationAttachment disturbances in young children: I: the continuum of caretaking casualty
SMYKE, A. T., DUMITRESCU, A., & ZEANAH, C. H. (2002) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200208000-00016 · Cited by 362 · see citing works
Self-citationPlacement in foster care enhances quality of attachment among young institutionalized children
Smyke, A. T., Zeanah, C. H., Fox, N. A., Nelson, C. A., & Guthrie, D. (2010) · Child Development · doi:10.1111/j.1467-8624.2009.01390.x · Cited by 324 · see citing works
Self-citationThe caregiving context in institution-reared and family-reared infants and toddlers in Romania
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 (2007) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2006.01694.x · Cited by 319 · see citing works
Self-citationPROVENCE, S. A., & Lipton, R. C. (1963) · Cited by 307 · see citing works
Effects of psychological deprivation in infancy and subsequent stimulation
GOLDFARB, W. (1945) · American Journal of Psychiatry · doi:10.1176/ajp.102.1.18 · Cited by 275 · see citing works
Psychological privation in infancy and subsequent adjustment
Goldfarb, W. (1945) · American Journal of Orthopsychiatry · doi:10.1111/j.1939-0025.1945.tb04938.x · Cited by 232 · see citing works
Institutional care: risk from family background or pattern of rearing
Roy, P., Rutter, M., & Pickles, A. (2000) · Journal of Child Psychology and Psychiatry · doi:10.1017/s002196309900517x · Cited by 206 · see citing works
Vanderwert, R. E., Marshall, P. J., Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2010) · PLoS ONE · doi:10.1371/journal.pone.0011415 · Cited by 203 · see citing works
Self-citationBick, J., Zhu, T., Stamoulis, C., Fox, N. A., Zeanah, C., & Nelson, C. A. (2015) · JAMA Pediatrics · doi:10.1001/jamapediatrics.2014.3212 · Cited by 199 · see citing works
Self-citationHumphreys, K. L., Gleason, M. M., Drury, S. S., Miron, D., Nelson, C. A., Fox, N. A., & Zeanah, C. H. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00095-4 · Cited by 199 · see citing works
Self-citationRutter (2010) · doi:10.1111/j.1540-5834.2010.00548.x · Cited by 194 · see citing works
Zeanah, C. H., Gunnar, M. R., McCall, R. B., Kreppner, J. M., & Fox, N. A. (2011) · Monographs of the Society for Research in Child Development · doi:10.1111/j.1540-5834.2011.00631.x · Cited by 194 · see citing works
Self-citationSmyke, A. T., Zeanah, C. H., Gleason, M. M., Drury, S. S., Fox, N. A., Nelson, C. A., & Guthrie, D. (2012) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2011.11050748 · Cited by 181 · see citing works
Self-citationMcLaughlin, K. A., Zeanah, C. H., Fox, N. A., & Nelson, C. A. (2012) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2011.02437.x · Cited by 171 · see citing works
Self-citationFox, N. A., Almas, A. N., Degnan, K. A., Nelson, C. A., & Zeanah, C. H. (2011) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2010.02355.x · Cited by 160 · see citing works
Self-citationEarly adversity and neural correlates of executive function: Implications for academic adjustment
McDermott, J. M., Westerlund, A., Zeanah, C. H., Nelson, C. A., & Fox, N. A. (2012) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2011.09.008 · Cited by 146 · see citing works
Self-citation(2010) · ePrints Soton (University of Southampton) · Cited by 145 · see citing works
Infant rearing and problem behavior.
Goldfarb, W. (1943) · American Journal of Orthopsychiatry · doi:10.1111/j.1939-0025.1943.tb05996.x · Cited by 138 · see citing works
Recovering from early deprivation: attachment mediates effects of caregiving on psychopathology
McGoron, L., Gleason, M. M., Smyke, A. T., Drury, S. S., Nelson, C. A., Gregas, M. C., Fox, N. A., & Zeanah, C. H. (2012) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2012.05.004 · Cited by 133 · see citing works
Self-citationVanderwert, R. E., Zeanah, C. H., Fox, N. A., & Nelson, C. A. (2016) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2015.12.004 · Cited by 128 · see citing works
Self-citationRomania’s Abandoned Children: Deprivation, Brain Development, and the Struggle for Recovery
Nelson, C. A. (2014) · Cited by 117 · see citing works
Self-citationAlmas, A. N., Degnan, K. A., Radulescu, A., Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2012) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1121256109 · Cited by 115 · see citing works
Self-citationA New Model of Foster Care for Young Children: The Bucharest Early Intervention Project
Smyke, A. T., Zeanah, C. H., Fox, N. A., & Nelson, C. A. (2009) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2009.03.003 · Cited by 112 · see citing works
Self-citationIII. DEPRIVATION-SPECIFIC PSYCHOLOGICAL PATTERNS
Kumsta, R., Kreppner, J., Rutter, M. L., Beckett, C., Castle, J., Stevens, S. E., & Sonuga-Barke, E. J. S. (2010) · Monographs of the Society for Research in Child Development · doi:10.1111/j.1540-5834.2010.00550.x · Cited by 112 · see citing works
Infant development under environmental handicap.
Dennis, W., & Najarian, P. (1957) · Psychological Monographs: General and Applied · doi:10.1037/h0093705 · Cited by 109 · see citing works
Romania's abandoned children: Deprivation, brain development, and the struggle for recovery.
Billings, L. (2014) · Scientific American · Cited by 95 · see citing works
Troller‐Renfree, S., McDermott, J. M., Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2015) · Developmental Science · doi:10.1111/desc.12261 · Cited by 94 · see citing works
Self-citationMemory and executive functioning in 12‐year‐old children with a history of institutional rearing
Bick, J., Zeanah, C. H., Fox, N. A., & Nelson, C. A. (2018) · Child Development · doi:10.1111/cdev.12952 · Cited by 90 · see citing works
Self-citationThe Ethics of International Research with Abandoned Children
Millum, J., & Emanuel, E. J. (2007) · Science · doi:10.1126/science.1153822 · Cited by 75 · see citing works
The Bucharest Early Intervention Project: Case Study in the Ethics of Mental Health Research
Zeanah, C. H., Fox, N. A., & Nelson, C. A. (2012) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e318247d275 · Cited by 74 · see citing works
Self-citationHumphreys, K. L., Nelson, C. A., Fox, N. A., & Zeanah, C. H. (2017) · Development and Psychopathology · doi:10.1017/s0954579417000256 · Cited by 74 · see citing works
Self-citationKreppner, J., Kumsta, R., Rutter, M. L., Beckett, C., Castle, J., Stevens, S. E., & Sonuga-Barke, E. J. S. (2010) · Monographs of the Society for Research in Child Development · doi:10.1111/j.1540-5834.2010.00551.x · Cited by 73 · see citing works
Ahmad, A., Qahar, J., Siddiq, A., Majeed, A., Rasheed, J., Jabar, F., & Von Knorring, A. ‐. (2005) · Child: Care, Health and Development · doi:10.1111/j.1365-2214.2004.00477.x · Cited by 65 · see citing works
Almas, A. N., Degnan, K. A., Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2016) · Developmental Psychology · doi:10.1037/dev0000167 · Cited by 63 · see citing works
Self-citationZEANAH, C. H., KOGA, S. F., SIMION, B., STANESCU, A., TABACARU, C. L., FOX, N. A., NELSON, C. A., & BEIP CORE GROUP (2006) · Infant Mental Health Journal · doi:10.1002/imhj.20107 · Cited by 61 · see citing works
Self-citationAlmas, A. N., Degnan, K. A., Walker, O. L., Radulescu, A., Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2015) · Social Development · doi:10.1111/sode.12089 · Cited by 47 · see citing works
Self-citationHumphreys, K. L., McGoron, L., Sheridan, M. A., McLaughlin, K. A., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2015) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2015.09.010 · Cited by 41 · see citing works
Self-citationInfant rearing as a factor in foster home replacement
Goldfarb, W. (1944) · American Journal of Orthopsychiatry · doi:10.1111/j.1939-0025.1944.tb04861.x · Cited by 40 · see citing works
Troller-Renfree, S., McLaughlin, K. A., Sheridan, M. A., Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2017) · Biological Psychology · doi:10.1016/j.biopsycho.2016.04.008 · Cited by 35 · see citing works
Self-citationThe Randomized Controlled Trial as a Demonstration Project: An Ethical Perspective
Miller, F. G. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09040538 · Cited by 34 · see citing works
Congregate care for infants and toddlers: shedding new light on an old question
Harden, B. J. (2002) · Infant Mental Health Journal · doi:10.1002/imhj.10029 · Cited by 33 · see citing works
Intensive Intervention for Maltreated Infants and Toddlers in Foster Care
Zeanah, C. H., & Larrieu, J. A. (1998) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/s1056-4993(18)30246-3 · Cited by 33 · see citing works
Self-citationEffects of institutional vs. boarding home care on a group of infants
LEVY, R. J. (1947) · Journal of Personality · doi:10.1111/j.1467-6494.1947.tb01065.x · Cited by 22 · see citing works
Rid, A. (2012) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e318247d124 · Cited by 13 · see citing works
A Matter of Timing: Enhancing Positive Change for the Developing Brain.
Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2014) · Zero to three · Cited by 2 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 2
- Zeanah, 2011, Sensitive periods, vol. 76, 147
- Almas, 2015, The effects of early institutionalization and foster care intervention on children’s social behaviors at age 8, Soc Dev, 24, 225, 10.1111/sode.12089 · DOI · Paper page
Cited by
Sorted by citations
van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., Duschinsky, R., Fox, N. A., Goldman, P. S., Gunnar, M. R., Johnson, D. E., Nelson, C. A., Reijman, S., Skinner, G. C. M., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30399-2 · Cited by 306 · see citing works
Self-citationStein, A., Netsi, E., Lawrence, P. J., Granger, C., Kempton, C., Craske, M. G., Nickless, A., Mollison, J., Stewart, D. A., Rapa, E., et al. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30006-3 · Cited by 148 · see citing works
Wade, M., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2019) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1809145116 · Cited by 92 · see citing works
Self-citationWade, M., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.2556 · Cited by 74 · see citing works
Self-citationCatch-up growth, metabolic, and cardiovascular risk in post-institutionalized Romanian adolescents
Tang, A., Slopen, N., Nelson, C. A., Zeanah, C. H., Georgieff, M. K., & Fox, N. A. (2018) · Pediatric Research · doi:10.1038/s41390-018-0196-4 · Cited by 38 · see citing works
Self-citationKing, L. S., Guyon-Harris, K. L., Valadez, E. A., Radulescu, A., Fox, N. A., Nelson, C. A., Zeanah, C. H., & Humphreys, K. L. (2023) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20220672 · Cited by 29 · see citing works
“The goal of theBEIPwas to examine the impact on development of high-quality family-based care following exposure to institutional care in early life (10).”
BackgroundSelf-citationSlopen, N., Tang, A., Nelson, C. A., Zeanah, C. H., McDade, T. W., McLaughlin, K. A., & Fox, N. A. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000696 · Cited by 18 · see citing works
Self-citationGüleç, A., Güler, H. A., & Türkoğlu, S. (2024) · Chronobiology International · doi:10.1080/07420528.2024.2319218 · Cited by 3 · see citing works
- Authors
- Zeanah, C. H., Humphreys, K. L., Fox, N. A., & Nelson, C. A.
- Affiliations
- Tulane University (US)
- Stanford University (US)
- University of Maryland, College Park (US)
- Boston Children's Hospital (US)
- Corresponding author
- Zeanah, Charles H
- Venue
- Current Opinion in Psychology
- Publisher
- Elsevier BV
- Published
- 2017-06
- Volume
- 15
- Pages
- 182-188
- ISSN
- 2352-250X (ISSN-L)
- PMC
- PMC5607636
- OpenAlex
- W2594003355
- Cited by
- 115
- References
- 49
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 10 · 2023: 14 · 2022: 9 · 2021: 11 · 2020: 12 · 2019: 32 · 2018: 10 · 2017: 1
- FWCI
- 4.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Opinion in Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH091363)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U54HD090255)
- Topics
- Social Sciences › Safety Research › Child Welfare and Adoption
- Social Sciences › Education › Early Childhood Education and Development
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- foster care, institutional care, orphaned and abandoned children, Bucharest Early Intervention Project, quality of care, placement stability, child development, brain development, behavioral development, child welfare policy
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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