Foster care promotes adaptive functioning in early adolescence among children who experienced severe, early deprivation
Open accessAbstract
Background: Experiences in early life lay the foundation for later development and functioning. Severe psychosocial deprivation, as experienced by children in early institutional care, constitutes an adverse experience with long‐term negative consequences. The Bucharest Early Intervention Project sought to examine the effects of foster care as an alternative to institutional care for abandoned infants in Romanian institutions. Methods: At a mean age of 22 months, institutionalized children were randomized to foster care or care as usual. At age 12 years, we followed‐up with 98 of these children (50 randomized to foster care), as well as assessed 49 never institutionalized comparison children. Adaptive functioning was assessed across seven domains—mental health, physical health, substance use, risk‐taking behavior, family relations, peer relations, and academic performance. Children at or above the threshold for adaptive functioning in at least six of seven domains were classified as having overall adaptive functioning in early adolescence. Results: Among all children who had experienced severe early deprivation, 40% exhibited adaptive functioning. Children randomized to foster care were significantly more likely to exhibit adaptive functioning at age 12 years than children in the care as usual condition (56% vs. 23%). In support of external validity, children who met the threshold for adaptive functioning at age 12 years had higher IQs and were more physiologically responsive to stress. Among children randomized to foster care, children placed prior to age 20 months were more likely to meet the threshold for adaptive functioning than those placed after this age (79% vs. 46%). Conclusions: This study provides causal evidence that placing children into families following severe deprivation increases the likelihood of adaptive functioning in early adolescence.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 48 cited sources checked · 0 supported · 0 flagged
- Findingown data
Among ever institutionalized children, there was a trend for greater heart rate reactivity in those classified as having adaptive functioning compared with those not so classified.
“For HR reactivity, there was a trend for greater reactivity among classified as exhibiting adaptive functioning compared to those who did not.”
Quote in the paperNot a substantial claim- Rests on an assumption: IQ and physiological stress reactivity are valid external markers of adaptive functioning.
- Findingown data
Among ever institutionalized children, those classified as having adaptive functioning had greater pre-ejection period reactivity than those not so classified.
“children who were determined to exhibit adaptive functioning had significantly higher IQ scores, greater DBP reactivity, and greater PEP reactivity compared to those who did not.”
Quote in the paperNot a substantial claim- Rests on an assumption: IQ and physiological stress reactivity are valid external markers of adaptive functioning.
- Findingown data
Within the foster care group, placement before 20 months predicted a higher rate of meeting the adaptive functioning threshold than placement after 20 months (79% vs. 46%).
“Among children randomized to foster care, children placed prior to age 20 months were more likely to meet the threshold for adaptive functioning than those placed after this age (79% vs. 46%).”
Quote in the paperSubstantial claim - Findingown data
At age 12, children randomly assigned to foster care were significantly more likely to meet the adaptive functioning threshold than those assigned to care as usual (56% vs. 23%; OR=4.28, 95% CI [1.79, 10.27]).
“Children randomized to foster care were significantly more likely to exhibit adaptive functioning at age 12 years than children in the care as usual condition (56% vs. 23%).”
- Also stated in: § Adaptive Functioning by Randomized Controlled Trial Group · plain
“there was a significant ITT effect, such that the FCG were more likely to exhibit adaptive functioning than the CAUG (OR=4.28 [1.79, 10.27]).”
Quote in the paperSubstantial claim - Also stated in: § Adaptive Functioning by Randomized Controlled Trial Group · plain
- Findingown data
At age 12, 40% of children who had ever been institutionalized met the study's threshold for adaptive functioning (at least 6 of 7 domains).
“Among all children who had experienced severe early deprivation, 40% exhibited adaptive functioning.”
- Also stated in: § Adaptive Functioning by Institutional Care History · plain
“Forty percent of ever institutionalized (EIG) children (i.e., CAUG and FCG) were identified as having adaptive functioning (i.e., at least 6 of 7 domains)”
Quote in the paperNot a substantial claim - Also stated in: § Adaptive Functioning by Institutional Care History · plain
- Findingown data
Among ever institutionalized children, those classified as having adaptive functioning had greater diastolic blood pressure reactivity than those not so classified.
“children who were determined to exhibit adaptive functioning had significantly higher IQ scores, greater DBP reactivity, and greater PEP reactivity compared to those who did not.”
Quote in the paperNot a substantial claim- Rests on an assumption: IQ and physiological stress reactivity are valid external markers of adaptive functioning.
- Findingown data
At age 12, never institutionalized children were more likely to meet the adaptive functioning threshold than ever institutionalized children (82% vs. 40%).
“Forty percent of ever institutionalized (EIG) children (i.e., CAUG and FCG) were identified as having adaptive functioning (i.e., at least 6 of 7 domains), which was less than half of the NIG group’s percentage (82%)”
Quote in the paperNot a substantial claim- Rests on an assumption: The never institutionalized comparison group is representative of typically developing Romanian children.
- Findingown data
Among ever institutionalized children, adaptive functioning classification was not significantly associated with cortisol reactivity during the laboratory stressor.
“Adaptive functioning was not significantly associated with cortisol reactivity during the laboratory-based stressor.”
Quote in the paperNot a substantial claim- Rests on an assumption: IQ and physiological stress reactivity are valid external markers of adaptive functioning.
- Findingown data
In intent-to-treat comparisons, adaptive functioning differed significantly between foster care and care as usual groups in only two domains: academic performance and peer relations.
“Tests revealed that adaptive functioning significantly differed in only two domains (i.e., academic performance and peer relations).”
Quote in the paperSubstantial claim - Findingown data
Among ever institutionalized children, those classified as having adaptive functioning had higher IQ scores than those not so classified.
“children who were determined to exhibit adaptive functioning had significantly higher IQ scores, greater DBP reactivity, and greater PEP reactivity compared to those who did not.”
Quote in the paperNot a substantial claim- Rests on an assumption: IQ and physiological stress reactivity are valid external markers of adaptive functioning.
- Findingown data
Among children in the ever-institutionalized group, girls had higher odds than boys of exhibiting adaptive functioning (OR=2.50, 95% CI 1.09-5.75).
“EIG girls were more likely than EIG boys to exhibit adaptive functioning (OR=2.50 [1.09, 5.75])”
Quote in the paperNot a substantial claim - Findingown data
Among ever-institutionalized children, 40% exhibited adaptive functioning (at least 6 of 7 domains) in early adolescence.
“we found significant heterogeneity in outcomes in children who were previously institutionalized, as 40% of ever institutionalized children exhibited adaptive functioning (i.e., at least 6 of 7 domains) in early adolescence.”
Quote in the paperNot a substantial claim- Rests on an assumption: The threshold of at least 6 of 7 domains validly classifies adaptive functioning.
- Findingown data
Among children placed into study-sponsored foster families, those placed by age 20 months were significantly more likely to exhibit adaptive functioning than those placed later (11/14 vs 16/35; OR=4.35, 95% CI 1.03-18.37).
“Those children who were placed into families by age 20 months were significantly more likely to exhibit adaptive functioning (11/14) than children placed after this age (16/35; OR=4.35 [1.03, 18.37]).”
Quote in the paperNot a substantial claim - Findingown data
Among children in the ever-institutionalized group, greater time spent in institutional care, assessed at ages 30 months, 42 months, 54 months, 8 years, and 12 years, was associated with reduced likelihood of exhibiting adaptive functioning.
“increased time spent in care, assessed at the various assessment waves, was associated with reduced likelihood of exhibiting adaptive functioning: age 30 months (B=−0.03, SE=0.01, Wald χ2(1)=11.29, p<.001), 42 months (B=−0.04, SE=0.01, Wald χ2(1)=12.97, p<.001), 54 months (B=−0.04, SE=0.01, Wald χ2(1)=12.83, p<.001), 8 years (B=−0.05, SE=0.01, Wald χ2(1)=11.53, p<.001), and 12 years (B=−0.05, SE=0”
Quote in the paperSubstantial claim - Findingown data
Girls were more likely than boys to show adaptive functioning.
“In addition to family-based care, being a girl is associated with increased likelihood of exhibiting adaptive functioning.”
Quote in the paperNot a substantial claim - Findingown data
Peer relations and academic performance were the domains most strongly correlated with overall adaptive functioning.
“Indeed, those two domains demonstrated the highest correlation with overall adaptive functioning.”
Quote in the paperNot a substantial claim - Findingown data
For the two domains reported by adolescents-substance use and risk-taking-the three groups did not differ significantly.
“Notably, in the two domains in which the adolescent was the informant (i.e., substance use and risk-taking behavior), there were no significant differences between the three groups, which could indicate a true lack of differences in these domains or potential biases in self-report.”
Quote in the paperNot a substantial claim - Findingown data
Average IQ was relatively low in the EIG, including among children who showed adaptive functioning.
“The EIG have relatively low IQ levels, on average, even among those who exhibited adaptive functioning, and there are known methodological concerns regarding self-report data among individuals with intellectual disabilities (Finlay & Lyons, 2001).”
Quote in the paperNot a substantial claim - Findingown data
Cortisol reactivity did not distinguish children who showed adaptive functioning from those who did not.
“It is worth noting that cortisol reactivity, perhaps the most commonly studied metric of physiological stress response, did not differentiate those who did and did not exhibit adaptive functioning.”
Quote in the paperNot a substantial claim - Premisecitation
The Bucharest Early Intervention Project is the sole randomized trial comparing foster care with institutional care for abandoned children.
“the only randomized controlled trial (RCT) for foster care as an alternative to institutional care.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Zeanah et al., 2003
Not checked in the free run.
- Interpretationown data
Family placement after severe early deprivation causally raises the chance of adaptive functioning by early adolescence.
“This study provides causal evidence that placing children into families following severe deprivation increases the likelihood of adaptive functioning in early adolescence.”
Quote in the paperSubstantial claim - Premisecitation
Research on previously institutionalized children has largely concentrated on adverse outcomes such as psychopathology, cognitive deficits, and social problems.
“To date, however, most research on previously-institutionalized children has focused on negative developmental outcomes, including increases in psychopathology, cognitive deficits, and problems in social functioning (Almas et al., 2017; Almas, Degnan, Nelson, Zeanah, & Fox, 2016; Gunnar, Bruce, & Grotevant, 2000; Rutter, Sonuga-Barke, Beckett, et al., 2010; Zeanah et al., 2009).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Almas et al., 2017
Not checked in the free run.
- cites Almas, Degnan, Nelson, Zeanah, & Fox, 2016
Not checked in the free run.
- cites Gunnar, Bruce, & Grotevant, 2000
Not checked in the free run.
- Interpretationreasoning
Since adoption and placement decisions are not randomized, causal conclusions about family placement and later adaptive functioning after early deprivation are difficult.
“the nature of traditional adoption and placement decisions makes it difficult to draw conclusive links about the role of placement in families and subsequent likelihood of exhibiting adaptive functioning following early deprivation; it could be that high-functioning youth were selected for adoption by future parents or institution staff.”
Quote in the paperSubstantial claim - Premisecitation
Children adopted from institutions often have long-term developmental challenges across multiple domains.
“Children adopted from institutions often experience have long-term developmental challenges across domains (Fisher, Ames, Chisholm, & Savoie, 1997; Gunnar, 2001; Loman, Wiik, Frenn, Pollak, & Gunnar, 2009).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Fisher, Ames, Chisholm, & Savoie, 1997
Not checked in the free run.
- cites Gunnar, 2001
Not checked in the free run.
- cites Loman, Wiik, Frenn, Pollak, & Gunnar, 2009
Not checked in the free run.
- Premisecitation
Vorria and colleagues reported that 38% of 13-year-olds adopted from institutional care in Athens had good outcomes.
“Vorria and colleagues (Vorria et al., 2015) examined functioning in 52 adolescents at age 13 years from the Metera Babies Center in Athens, Greece, and found that 38% of children adopted out of institutional care were classified as having “good” outcomes.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Vorria et al., 2015
Not checked in the free run.
- Study design and conductown data
The originally followed and newly recruited never institutionalized children had similar adaptive functioning.
“Original and new NIG participants did not significantly differ (χ2(1)=2.11, p=.146) in adaptive functioning”
Quote in the paperNot a substantial claim - Study design and conductown data
Participants retained at age 12 and those with complete data did not differ significantly from those lost or incomplete on several birth and institutional care variables.
“Participants who did and did not participate at age 12 years and those with and without complete data at age 12 years did not significantly differ (ps>.10) in gestational age at birth, birth weight, APGAR score (if known), age when placed into the institution, or the percent time in institutional care at baseline.”
Quote in the paperSubstantial claim - Study design and conductcitation
At baseline, the foster care and care as usual groups were statistically comparable on demographic, developmental, caregiving, and caregiver-rated behavior measures.
“The children in the two groups did not significantly differ in terms of age, gender, ethnicity, birth weight, developmental quotient, observed caregiving environment, caregiver ratings of behavior problems and competence at baseline (Smyke et al., 2007).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Smyke et al., 2007
Not checked in the free run.
- Study design and conductreasoning
The randomized controlled trial design of BEIP allows differences between the CAUG and FCG to be causally attributed to the intervention.
“The RCT design of BEIP goes one step further, as any differences found between the groups randomized to either CAUG or FCG can be causally attributed to the intervention.”
Quote in the paperSubstantial claim - Interpretationreasoning
The study's randomized design supports a causal conclusion that foster care improved adaptive functioning after deprivation.
“Thus, our unique study design allows us to provide compelling evidence that the foster care intervention promoted adaptive functioning following deprivation.”
Quote in the paperSubstantial claim- Rests on an assumption: The threshold of at least 6 of 7 domains validly classifies adaptive functioning.
- Rests on an assumption: The seven domains selected a priori adequately capture adaptive functioning following adversity.
- Interpretationcitation
BEIP evidence indicates that institutionalized children do better in family-based care than in institutional care.
“For institutionalized children, evidence from the BEIP suggest that family-based care is preferable to institutional care, and that such placements should occur as early in life as possible, and should be stable across the child’s life (Humphreys, Gleason, et al., 2015; Vanderwert, Zeanah, Fox, & Nelson, 2016).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Humphreys, Gleason, et al., 2015
Not checked in the free run.
- cites Vanderwert, Zeanah, Fox, & Nelson, 2016
Not checked in the free run.
- Rests on an assumption: The BEIP findings about family placement can be generalized to orphaned or abandoned children more broadly.
- Premisecitation
Sensitive periods, times of greater developmental plasticity, permit more adaptation to both positive and negative environments.
“Developmental periods characterized by heightened plasticity, often termed sensitive periods, allow for greater adaptation to both positive and negative environments.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Nelson et al., 2014
Not checked in the free run.
- cites Rutter, 2001
Not checked in the free run.
- cites Vorria et al., 2015
Not checked in the free run.
- Premisecitation
Findings from BEIP and other research suggest that early sensitive periods matter for recovery from severe psychosocial deprivation.
“Increasing evidence from the BEIP and other studies indicate that sensitive periods exist in early life that are relevant to recovery from severe psychosocial deprivation (Nelson et al., 2014; Rutter, 2001; Vorria et al., 2015).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Nelson et al., 2014
Not checked in the free run.
- cites Rutter, 2001
Not checked in the free run.
- cites Vorria et al., 2015
Not checked in the free run.
- Premisecitation
For children placed after 6 months, extra time in care (6-24 versus 24-42 months) was not significantly associated with impairment in early adolescence.
“However, among children placed after 6 months, cutoffs based on additional time in care (i.e., 6–24 months vs. 24–42 months) did not significantly relate to impairment in early adolescence.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Kreppner et al., 2007
Not checked in the free run.
- Interpretationreasoning
For orphaned or abandoned children, giving them a stable caregiver may be the most powerful resource for improving well-being.
“The notion of interventions that are “asset-building” to promote adaptive functioning following adversity can be applied to the context of the present study, as providing a family (i.e., a stable caregiver) for orphaned or abandoned children is perhaps the strongest asset for improving their well-being.”
Quote in the paperNot a substantial claim- Rests on an assumption: The BEIP findings about family placement can be generalized to orphaned or abandoned children more broadly.
- Interpretationown data
The present results agree with earlier work in pointing to longer institutional care as a barrier to later adaptive functioning.
“These findings are in concert with our own, highlighting duration of institutional care as an impediment to later adaptive functioning.”
Quote in the paperSubstantial claim - Interpretationreasoning
Adaptive functioning can be fostered by positive environments.
“Perhaps most important to emphasize is that adaptive functioning can be fostered by positive environments.”
Quote in the paperSubstantial claim- Rests on an assumption: The threshold of at least 6 of 7 domains validly classifies adaptive functioning.
- Rests on an assumption: The seven domains selected a priori adequately capture adaptive functioning following adversity.
- Interpretationreasoning
Overall, the findings raise the possibility of a sensitive period for family placement, during which later adaptive functioning is more easily supported.
“Taken together, these results suggest the potential for a sensitive period for the impact of family placements in which later adaptive functioning may be more easily facilitated.”
Quote in the paperSubstantial claim- Rests on an assumption: The threshold of at least 6 of 7 domains validly classifies adaptive functioning.
- Rests on an assumption: The seven domains selected a priori adequately capture adaptive functioning following adversity.
- Interpretationown data
Institutional care history did not moderate the sex difference in adaptive functioning.
“Not only were girls from our study more likely to exhibit adaptive functioning following psychosocial deprivation, there was some evidence that never institutionalized girls were more likely to exhibit adaptive functioning, indicating that sex differences were not moderated by institutional care history.”
Quote in the paperNot a substantial claim - Interpretationown data
Cortisol reactivity might index stress exposure better than it indexes adaptive functioning.
“Despite finding an ITT effect for cortisol reactivity to stress (McLaughlin et al., 2015), differences based on adaptive functioning group, though in the expected direction, did not reach statistical significance, indicating that this metric may be a better marker of stress exposure than adaptive functioning.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites McLaughlin et al., 2015
Not checked in the free run.
- Interpretationown data
Foster care placement after institutional rearing increases adaptive functioning.
“In conclusion, findings from the present research indicates that placement into foster care following institutional care promotes adaptive functioning.”
Quote in the paperSubstantial claim- Rests on an assumption: The threshold of at least 6 of 7 domains validly classifies adaptive functioning.
- Rests on an assumption: The seven domains selected a priori adequately capture adaptive functioning following adversity.
- Study design and conductown data
Because many children had changed placements by age 12, the intention-to-treat analyses may underestimate the foster care effect.
“As a related point, our ITT analyses may be overly conservative in estimating the effect of the foster care intervention, given that many children at age 12 years were no longer in the same placement as following randomization.”
Quote in the paperNot a substantial claim - Study design and conductnone given
Other measures of institutional care, such as age at foster placement and percentage of time in institutional care, correlate with ITT group.
“While alternative metrics assessing aspects of institutional care were considered (i.e., age of placement into foster care; percent time in institutional care), these variables are correlated with ITT group.”
Quote in the paperNot a substantial claim
- May combine two claims. 23
- Classified as probably not a substantial claim. 38
- The quote only partly states this claim. 1
May combine two claims.
Findingown dataAmong both boys and girls separately, there was evidence of an intention-to-treat effect and an effect of institutional care history on the likelihood of overall adaptive functioning.
“Within each sex separately there was evidence of both an ITT effect and effect of institutional care history on likelihood of exhibiting overall adaptive functioning.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAmong children in the never-institutionalized group, girls had higher odds than boys of exhibiting adaptive functioning, but the effect did not reach statistical significance (OR=5.25, 95% CI 0.96-28.57).
“though the same effect, while larger in magnitude, did not reach statistical significance in the NIG (OR=5.25 [0.96, 28.57])”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataIn a binary logistic regression, sex and group each had main effects (Wald(1)=8.17, p=.014; Wald(2)=28.69, p<.001), with no significant sex-by-group interaction (Wald(2)=0.50, p=.781).
“A binary logistic regression of sex by group (dummy-coded) indicated main effects of each (Wald(1)=8.17, p=.014 and Wald(2)=28.69, p<.001, respectively), and there was no significant sex by group interaction (Wald(2)=0.50, p=.781).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataUsing a 24-month placement cutoff, children placed earlier were somewhat more likely to exhibit adaptive functioning (16/24, 67%) than those placed later (11/25, 44%), but the effect was not statistically significant (OR=2.54, 95% CI 0.80-8.11).
“A similar, although not statistically significant effect was found by using a placement age of 24 months, as those placed prior to this age were somewhat more likely to exhibit adaptive functioning (16/24) than those placed after this age (67% vs. 44%, (11/25; OR=2.54 [0.80, 8.11]).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataBy age 12, about half of the FCG had left their original foster placement, and many CAUG children had later entered family care.
“Approximately half of children in the FCG were no longer in their original foster care placement at age 12, and many CAUG were subsequently placed in family care.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPrior research shows heterogeneity in outcomes among previously institutionalized children, with a subset exhibiting adaptive functioning after early institutionalization.
“However, heterogeneity in these outcomes is common. A subset of previously institutionalized children appear to exhibit adaptive functioning following exposure to institutionalization in early childhood (Kreppner et al., 2007; Vorria, Ntouma, & Rutter, 2015).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Kreppner et al., 2007
Not checked in the free run.
- cites Vorria, Ntouma, & Rutter, 2015
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe foster-care program in BEIP was intended to be low-cost, reproducible, and based on developmental research about caregiving quality.
“The foster-care intervention was designed to be affordable, replicable, and grounded in developmental research on caregiving quality (Nelson, Fox, & Zeanah, 2014; Smyke, Zeanah, Fox, & Nelson, 2009).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Nelson, Fox, & Zeanah, 2014
Not checked in the free run.
- cites Smyke, Zeanah, Fox, & Nelson, 2009
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductown dataInstitutionalized children were randomly assigned to foster care or care as usual after baseline assessment.
“institutionalized children from six Bucharest institutions were randomized into either high-quality foster care or to the care as usual condition.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataGroup assignment could not be masked from children, caregivers, or investigators, but the age-12 IQ testing was done by a research assistant who did not know the sample.
“Masking group assignments to children, their caregivers, or study investigators was not possible, although IQ assessments at age 12 were administered by a research assistant unfamiliar with the study sample.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationThe English and Romanian Adoptees Study found that 92% of children adopted by UK families before 6 months met the adaptive functioning threshold at age 11, versus 50% of those adopted later.
“Within the English and Romanian Adoptees Study (ERAS; Rutter, Sonuga-Barke, & Castle, 2010), among Romanian children who were previously institutionalized and adopted by families in the United Kingdom by age 6 months, 92% were identified as meeting the threshold for adaptive functioning (using a cutoff based on functioning in at least 6 of 7 domains) at age 11 years; whereas only 50% were deter”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kreppner et al., 2007
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe study translated all measures into Romanian and back into English, with bilingual staff checking meaning at each step.
“All measures were translated into Romanian, then back translated into English, and assessed for meaning at each step by bilingual research staff.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe Risk-taking Behavior scale had fair internal reliability (α=.64).
“The reliability was fair (α=.64).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe MacArthur Health and Behavior Questionnaire is a validated instrument for ages 4 to 18 and has previously been used with institutionally reared children.
“The HBQ is a well-validated assessment of children ranging from 4 to 18 years, and has been previously used to assess emotional and behavioral adjustment in institutionally reared children (Wiik et al., 2011).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Wiik et al., 2011
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe trial was registered with ClinicalTrials.gov under number NCT00747396.
“This trial is registered with ClinicalTrials.gov, number NCT00747396.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationPlacement with families after early psychosocial deprivation is regarded as protective and as a natural experiment for studying how placement status and age at placement affect children.
“Family placements, known to be protective following adoption after early psychosocial deprivation, are considered natural experiments, in which circumstances allow for researchers to examine placement status as well as age of placement on child outcomes (Rutter, Kumsta, Schlotz, & Sonuga-Barke, 2012).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Rutter, Kumsta, Schlotz, & Sonuga-Barke, 2012
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataThe study received ethical approval from institutional review boards and local child protection commissions, and guardian consent and child assent were obtained.
“After approval by the institutional review boards of the three principal investigators (CAN, NAF, and CHZ), and by the local Commissions on Child Protection in Bucharest, the study started in collaboration with the Institute of Maternal and Child Health of the Romanian Ministry of Health. At the age 12 year follow-up, each child’s legal guardian signed consent for participation as per Romanian law”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationIt is thought that long-lasting hazards generally raise the chance of developmental problems and lower the chance of resilience after adversity.
“Prolonged hazards of all types are thought to increase the risk for developmental difficulties and reduce the likelihood of resilience following adversity (Masten, 2001).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Masten, 2001
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe Family Relations scale had good internal reliability (α=.77).
“The reliability for the scale was good (α=.77).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe Peer Relations scale had good internal reliability (α=.81).
“The reliability for the scale was good (α=.81).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe WISC-IV is a commonly used individually administered test of children's cognitive ability.
“The WISC-IV is a widely used, individually administered instrument for assessing the cognitive abilities of children.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Wechsler, 2004 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe Mental Health scale had good internal reliability (α=.87).
“The reliability for the scale was good (α=.87).”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenIntent-to-treat analyses kept participants in their originally assigned groups, irrespective of later or current placements.
“For ITT analyses, all participants were analyzed according to original group assignment, regardless of subsequent or current placements.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe Academic Performance scale had very good internal reliability (α=.91).
“The reliability for this scale was very good (α=.91).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe Social Skills Rating System has good reliability and validity.
“It has been shown to have good reliability and validity (Gresham, Elliott, Vance, & Cook, 2011).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Gresham, Elliott, Vance, & Cook, 2011
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationFor children who were sexually abused, later functioning is linked to stressor characteristics including how long it lasted, how severe it was, and the child's age.
“For example, among children who experienced maltreatment in the form of sexual abuse, a large body of work has identified that aspects of the stressor (e.g., duration, severity, age of the child) are associated with likelihood of later functioning (Spaccarelli & Kim, 1995).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Spaccarelli & Kim, 1995
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn research on people exposed to various adversities, how many show adaptive functioning varies substantially with the particular features of the adversity.
“Across studies following individuals who experienced different forms of adversity, the percentage of individuals who exhibit adaptive functioning depends greatly on specific features of the adversity they experienced.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Spaccarelli & Kim, 1995
Not checked in the free run.
May combine two claims.
PremisecitationBEIP sensitive-period results mostly point to 18-24 months as a key transition, with earlier placement linked to greater recovery from psychosocial deprivation.
“The majority of sensitive period findings in BEIP suggest that sometime between 18–24 months is an important turning point in development, such that placement before that age is associated with more recovery from psychosocial deprivation (Nelson et al., 2014; Nelson, Fox, & Zeanah, 2017; Zeanah, Gunnar, McCall, Kreppner, & Fox, 2011).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Nelson et al., 2014
Not checked in the free run.
- cites Nelson, Fox, & Zeanah, 2017
Not checked in the free run.
- cites Zeanah, Gunnar, McCall, Kreppner, & Fox, 2011
Not checked in the free run.
May combine two claims.
PremisecitationERAS researchers reported large differences at age 11 among previously institutionalized children according to whether family placement occurred by 6 months, with almost all placed by then showing resilience.
“Researchers from the ERAS noted dramatically different outcomes at age 11 years among previously institutionalized children based on whether or not they had been placed in families by age 6 months (Kreppner et al., 2007), with nearly all children placed by 6 months demonstrating resilience to adversity.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Kreppner et al., 2007
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMasten (2001) described assets or resources that seem to predict resilience, often things that can be added to a child's life to offset risks.
“Masten (2001) identified “assets” or resources that appear to predict resilience, these features are often variables that can be added to a child’s life (e.g., a caring mentor) to counterbalance risk factors.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Masten, 2001
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). The quote only partly states this claim.
InterpretationreasoningAssets may be more effectively built earlier in development.
“In addition, the building of such assets may be greater earlier in development.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.
InterpretationreasoningFamily placement after institutionalization can be seen as both removing a risk and adding a resource.
“Considered another way, placement into family care following institutionalization couples both “hazard” removal and “asset” building.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationVorria et al. (2015) studied four domains in the Metera Babies Centre sample, scoring each from 0 to 4.
“In the Metera Babies Centre study, Vorria et al. (2015) focused on 4 domains (i.e., quality of attachment; cognitive performance; hyperactivity; request for psychiatric services), in which scores were given from 0 to 4 for each domain.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Vorria et al., 2015
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIt is well established that girls tend to recover better than boys after adversity.
“Sex differences favoring girls’ recovery following adversity is well established (see Rutter, 1987).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Rutter, 1987
Not checked in the free run.
May combine two claims.
PremisecitationIn the Metera Babies Centre study, the strongest predictor of resilience in early adolescence was how long children had been in institutional care; those still in care after age 2 had worse outcomes than those placed earlier.
“More similar to our own findings, work from the Metera Babies Centre found that the largest predictor of early adolescent resilience was the length of time in institutional care, with those children who remained in care past age 2 years having significantly worse outcomes than those placed before that age (Vorria et al., 2015).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Vorria et al., 2015
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductcitationThere is no field consensus on which domains matter, what thresholds define adaptive functioning, or how many domains must be met after adversity.
“the field has yet to reach consensus on (a) salient domains, (b) thresholds for determining adaptive functioning, and (c) how many areas in which one must meet this threshold to be considered to be functioning adaptively following adversity (see Luthar, Cicchetti, & Becker, 2000; Masten et al., 1999).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Luthar, Cicchetti, & Becker, 2000
Not checked in the free run.
- cites Masten et al., 1999
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMcGloin and Widom (2001) reported that, in a longitudinal maltreatment sample, girls were significantly more likely than boys to be resilient.
“McGloin and Widom’s (2001) study on longitudinal outcomes following child maltreatment found a significant sex difference indicating that girls with maltreatment histories were significantly more likely to be resilient than maltreated boys.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites McGloin and Widom, 2001
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe ERAS assessed seven domains and used the 15th percentile as the impairment cutoff, except for one domain that used a clinical diagnosis.
“In the ERAS, 7 domains (i.e., cognitive impairment, quasi-autistic patterns, inattention/overactivity, disinhibited attachment, conduct, emotional, and peer relationship problems) were assessed, and being at the 15th percentile was required as the cutoff for impairment (with the exception of one domain in which a clinical diagnosis was used; Kreppner et al., 2007).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Kreppner et al., 2007
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationreasoningThe overall CAUG-FCG difference in adaptive functioning might reflect cumulative effects across domains or be driven by particular domains like peer relations and academic performance.
“Perhaps because of this approach, several domains indicated no significant ITT effect (e.g., including mental health impairment [in contrast to recent findings of intervention effects at age 12 years based on symptom levels; Humphreys, Gleason, et al., 2015]), suggesting that the overall differences between the CAUG and FCG in overall adaptive functioning may have been cumulative across domains or”
Quote in the paperNot a substantial claim- Rests on an assumption: The seven domains selected a priori adequately capture adaptive functioning following adversity.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
InterpretationreasoningMultiple factors probably contribute to adaptive functioning after adversity.
“We are unable to conclude, specifically, why each child did or did not exhibit adaptive functioning, although it is likely that there are multiple factors that play a role in predicting adaptive functioning following adversity.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSelf-report data from people with intellectual disabilities raise known methodological concerns.
“there are known methodological concerns regarding self-report data among individuals with intellectual disabilities (Finlay & Lyons, 2001).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Finlay & Lyons, 2001
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningThe domains were chosen in advance to cover a broad range of functioning based on earlier resilience research, not because they had previously shown intervention effects.
“The domains were selected a priori for inclusion, as we attempted to assess a wide range of functioning inspired by previous studies of resilience rather than selecting those domains in which we previously found evidence for an intervention effect.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningThe criteria for adaptive functioning were informed by earlier research but were necessarily somewhat arbitrary.
“In terms of our determination of adaptive functioning, choices made were guided by prior work but were somewhat arbitrary by necessity.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMcGloin and Widom (2001) operationalized resilience as meeting criteria in at least six of eight domains.
“McGloin and Widom (2001) followed a large number of children with and without substantiated maltreatment cases, and defined resilience as adaptive functioning in at least 6 of 8 domains (i.e., arrest records, education, employment, homelessness, psychiatric disorder, self-reported of violence, and substance abuse).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites McGloin and Widom, 2001
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataSome participants have dropped out since randomization.
“Second, participant attrition has occurred since the initial randomization.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningNeither caregivers, children, nor laboratory staff were blinded to intervention condition.
“First, as noted above, the nature of the intervention meant that caregivers, children, and laboratory staff were not blind to condition.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationOne framework proposes that links between risk factors and adverse outcomes are modifiable, with personal characteristics and circumstances increasing either vulnerability or protection.
“Such an approach is consistent with a framework in which the association between risk factor and adverse outcomes can be modified, specifically noting that individual features and circumstances may promote vulnerability, whereas others may promote protection (Rutter, 1987, 1996, 1999).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Rutter, 1987
Not checked in the free run.
- cites Rutter, 1996
Not checked in the free run.
- cites Rutter, 1999
Not checked in the free run.
May combine two claims.
Interpretationown dataChildren placed earlier and those who spent less time in institutional care tend to have better outcomes in early adolescence.
“Earlier placements and reduced overall time in institutional care appears to be associated with better outcomes for these children in early adolescence.”
Quote in the paperSubstantial claim- Rests on an assumption: The threshold of at least 6 of 7 domains validly classifies adaptive functioning.
- Rests on an assumption: The seven domains selected a priori adequately capture adaptive functioning following adversity.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningIt remains possible that those lost to follow-up would have changed the results.
“Although we attempted to examine difference between those individuals who did and did not participate in the present follow-up, we cannot rule out the possibility that those individuals not included would have altered the findings.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The never institutionalized comparison group is representative of typically developing Romanian children.
“They served as a typically developing comparison group (never institutionalized group, NIG).”
“a third group of Romanian children who had never been placed in an institution were recruited from pediatric clinics and schools in Bucharest were matched on age and gender to the randomized children.”
The paper relies on this without support.
IQ and physiological stress reactivity are valid external markers of adaptive functioning.
“the overall composite score, or Full Scale IQ (IQ), was used as an external, examiner assessed marker of adaptive functioning with which to compare with the group determinations.”
“Diastolic blood pressure (DBP) reactivity, heart rate (HR) reactivity, pre-ejection period (PEP) reactivity, and cortisol reactivity to the TSST were selected as physiological markers of adaptive functioning with which to examine external validity to adaptive functioning determinations.”
The paper relies on this without support.
The threshold of at least 6 of 7 domains validly classifies adaptive functioning.
“In terms of our determination of adaptive functioning, choices made were guided by prior work but were somewhat arbitrary by necessity.”
The paper relies on this without support.
The seven domains selected a priori adequately capture adaptive functioning following adversity.
“The domains were selected a priori for inclusion, as we attempted to assess a wide range of functioning inspired by previous studies of resilience rather than selecting those domains in which we previously found evidence for an intervention effect.”
The paper relies on this without support.
The BEIP findings about family placement can be generalized to orphaned or abandoned children more broadly.
“providing a family (i.e., a stable caregiver) for orphaned or abandoned children is perhaps the strongest asset for improving their well-being.”
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?
Foster care intervention was associated with improved peer relationships, social functioning, and adaptive functioning compared to CAUG.
“improved peer relationships, social functioning (Almas et al., 2015;Humphreys et al., 2018;Levin et al., 2015;Wade et al., 2020b) and adaptive functioning (Hare et al., 2026;Humphreys et al., 2018) compared to CAUG.”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Humphreys et al., 2018
The Results (Adaptive Functioning by Randomized Controlled Trial Group; page not provided) report significantly better peer relations and overall adaptive functioning in the foster care group than in CAUG. The paper does not report a separate improvement in social functioning as a whole; that broader part of the claim is not established by these results. (LLM, conf=0.85)
Experimental — accuracy not yet measuredFoster care intervention in the BEIP is associated with increased social functioning.
“↑ Social functioning (Almas et al., 2015;Humphreys et al., 2018;Wade et al., 2020b)”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Humphreys et al., 2018
Foster care intervention was associated with moderate improvements in adaptive functioning.
“Strong improvements in attachment disorder symptoms; moderate improvements in externalizing symptoms and adaptive functioning; weak improvements in internalizing symptoms for boys (strong for girls)”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Humphreys et al., 2018
This disadvantage was measured in relation to a variety of domains, including behavioural, socio-emotional, psychological and medical.
“This disadvantage was measured in relation to a variety of domains, including behavioural (Humphreys et al. 2018; MacKenzie et al., 2017; Nsabimana et al., 2019; Troller-Renfree et al., 2016), socio-emotional”
From Residential care as an alternative care option: A review of literature within a global context (2022) · cites this paper as Humphreys et al. 2018
Children with institutional care histories are more likely than never institutionalized peers to have health difficulties in early adolescence that limit functioning.
“Aside from psychological and academic concerns, children with a history of institutional care are also more likely than their never institutionalized peers to have health difficulties in early adolescence that limit their ability to function (Humphreys et al., 2018).”
From Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation (2021) · cites this paper as Humphreys et al., 2018
In a prior BEIP analysis, 12-year-old children randomized to foster care, especially before age 20 months, had higher overall adaptive functioning than those placed later or remaining in institutional care.
“Children randomized to removal from institutional care and placement into foster families, particularly prior to age 20 months, had higher rates of overall adaptive functioning compared to those placed in family care at later ages or those who remained in institutional care.”
From Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation (2021) · cites this paper as Humphreys et al., 2018
Children adopted out of institutional care at a younger age tend to have higher and more sustained competence in adolescence than children who remain in institutional care longer.
“Furthermore, children adopted out of institutional care at a younger age tend to have higher levels of competence and more sustained competence in adolescence compared to children who remain in institutional care for longer periods of time (Humphreys et al., 2018; Kreppner et al., 2007; Vorria et al., 2015), and in one study, similar levels of competence compared to never institutionalized adole”
From Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation (2021) · cites this paper as Humphreys et al., 2018
Prior findings indicate that children with institutional care histories tend to have lower competent functioning in early adolescence than never institutionalized community children.
“Previous findings (reviewed above) suggested that children with a history of institutional care tend to have lower levels of competent functioning in early adolescence compared to never institutionalized community children (Humphreys et al., 2018).”
From Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation (2021) · cites this paper as Humphreys et al., 2018
Children who met the age-12 competence threshold had high IQ scores and greater diastolic blood pressure and pre-ejection period reactivity.
“Children who met the threshold for competence had high IQ scores and greater diastolic blood pressure and pre-ejection period reactivity.”
From Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation (2021) · cites this paper as Humphreys et al., 2018
The age-12 competence threshold (6+ of 7 domains) was previously established and validated against IQ and physiological reactivity.
“The threshold for competent functioning at age 12 (i.e., 6+ domains out of 7) was previously established in Humphreys and colleagues (2018) and validated against IQ and physiological reactivity to stress.”
From Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation (2021) · cites this paper as Humphreys et al., 2018
Children with a history of institutional care tend to have lower competent functioning at age 12 compared with never institutionalized community children.
“Previously, we demonstrated that children with a history of institutional care tend to have lower levels of competent functioning in adolescence (age 12 years) compared to never institutionalized community children (Humphreys et al., 2018).”
From Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation (2021) · cites this paper as Humphreys et al., 2018
The study replicates and extends previous work by showing that children who receive higher quality early caregiving and spend less time in institutions are more likely to achieve and maintain competent functioning.
“Our study replicates and extends previous work (Humphreys et al., 2018; Kreppner et al., 2007; Vorria et al., 2015) by demonstrating that children who receive higher quality caregiving early in life and spend less time being raised in institutions not only are more likely to achieve but also to maintain competent functioning.”
From Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation (2021) · cites this paper as Humphreys et al., 2018
The study's definition of competent functioning was externally validated at age 12 but not at ages 8 or 16.
“Second, our definition of competent functioning was externally validated at 12 years (Humphreys et al., 2018), but not previously at 8 or 16 years.”
From Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation (2021) · cites this paper as Humphreys et al., 2018
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- Consistentχ²(1) = 2.11reported p = .146 · recomputed p = .146
“χ2(1)=2.11, p = .146”
- Consistentχ²(1) = 11.29reported p < .001 · recomputed p < .001
“χ2(1)=11.29, p < .001”
- Consistentχ²(1) = 12.97reported p < .001 · recomputed p < .001
“χ2(1)=12.97, p < .001”
- Consistentχ²(1) = 12.83reported p < .001 · recomputed p < .001
“χ2(1)=12.83, p < .001”
- Consistentχ²(1) = 11.53reported p < .001 · recomputed p < .001
“χ2(1)=11.53, p < .001”
- Consistentχ²(1) = 9.78reported p = .002 · recomputed p = .002
“χ2(1)=9.78, p = .002”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Self-check results appear here once an independent check has confirmed them.
Cites
The Construct of Resilience: A Critical Evaluation and Guidelines for Future Work
Luthar, S. S., Cicchetti, D., & Becker, B. (2000) · Child Development · doi:10.1111/1467-8624.00164 · Cited by 9,381 · see citing works
Ordinary magic: Resilience processes in development.
Masten, A. S. (2001) · American Psychologist · doi:10.1037/0003-066x.56.3.227 · Cited by 8,497 · cited 2× · see citing works
“Prolonged hazards of all types are thought to increase the risk for developmental difficulties and reduce the likelihood of resilience following adversity (Masten, 2001).”
Psychosocial resilience and protective mechanisms.
Rutter, M. (1987) · American Journal of Orthopsychiatry · doi:10.1111/j.1939-0025.1987.tb03541.x · Cited by 5,831 · see citing works
The influence of parenting style on adolescent competence and substance use
Baumrind, D. (1991) · The Journal of Early Adolescence · doi:10.1177/0272431691111004 · Cited by 3,985 · see citing works
Masten, A. S., Hubbard, J., Gest, S. D., Tellegen, A., Garmezy, N., & Ramirez, M. (1999) · Development and Psychopathology · doi:10.1017/s0954579499001996 · Cited by 1,119 · see citing works
Handbook of developmental cognitive neuroscience
O’Connor, T. G. (2002) · Attachment & Human Development · Cited by 873 · see citing works
Finlay, W. M. L., & Lyons, E. (2001) · Psychological Assessment · doi:10.1037/1040-3590.13.3.319 · Cited by 521 · see citing works
Stress, risk, and resilience in children and adolescents: Processes, mechanisms, and interventions.
Haggerty, R. J. (1994) · Journal of Child Psychology and Psychiatry · Cited by 508 · see citing works
ZEANAH, 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 · cited 5× · see citing works
“The participants were from the Bucharest Early Intervention Project (BEIP; Zeanah et al., 2003), the only randomized controlled trial (RCT) of foster care as an alternative to institutional care.”
BackgroundMethodInfluentialSelf-citationResilience among abused and neglected children grown up
McGloin, J. M., & Widom, C. S. (2001) · Development and Psychopathology · doi:10.1017/s095457940100414x · Cited by 433 · see citing works
McLaughlin, 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-citationSpecificity and heterogeneity in children's responses to profound institutional privation
Rutter, M., Kreppner, J., & O'Connor, T. G. (2001) · British Journal of Psychiatry · doi:10.1192/bjp.179.2.97 · Cited by 418 · see citing works
Gresham, F. M., Elliott, S. N., Vance, M. J., & Cook, C. R. (2011) · School Psychology Quarterly · doi:10.1037/a0022662 · Cited by 368 · see citing works
Institutional rearing and psychiatric disorders in Romanian preschool children
Zeanah, C. H., Egger, H. L., Smyke, A. T., Nelson, C. A., Fox, N. A., Marshall, P. J., & Guthrie, D. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.08091438 · Cited by 365 · 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-citationWechsler Intelligence Scale for Children – Fourth UK Edition (WISC-IV UK)
Wechsler, D. (2004) · doi:10.53841/bpstest.2004.wisc4 · Cited by 306 · see citing works
International adoption of institutionally reared children: research and policy
GUNNAR, M. R., BRUCE, J., & GROTEVANT, H. D. (2000) · Development and Psychopathology · doi:10.1017/s0954579400004077 · Cited by 261 · see citing works
Resilience criteria and factors associated with resilience in sexually abused girls
Spaccarelli, S., & Kim, S. (1995) · Child Abuse & Neglect · doi:10.1016/0145-2134(95)00077-l · Cited by 258 · see citing works
ESSEX, M. J., BOYCE, W. T., GOLDSTEIN, L. H., ARMSTRONG, J. M., KRAEMER, H. C., & KUPFER, D. J. (2002) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200205000-00017 · Cited by 253 · see citing works
Problems Reported by Parents of Romanian Orphans Adopted to British Columbia
Fisher, L., Ames, E. W., Chisholm, K., & Savoie, L. (1997) · International Journal of Behavioral Development · doi:10.1080/016502597385441 · Cited by 232 · see citing works
Kreppner, J., Rutter, M. L., Beckett, C., Castle, J., Colvert, E., Groothues, C., Hawkins, A., O’Connor, T. G., Stevens, S. E., & Sonuga-Barke, E. J. S. (2007) · Developmental Psychology · doi:10.1037/0012-1649.43.4.93 · Cited by 231 · see citing works
Kreppner, J. M., Rutter, M., Beckett, C., Castle, J., Colvert, E., Groothues, C., Hawkins, A., O'Connor, T. G., Stevens, S., & Sonuga-Barke, E. J. S. (2007) · Developmental Psychology · doi:10.1037/0012-1649.43.4.931 · Cited by 231 · see citing works
Romania's Abandoned Children: Deprivation, Brain Development, and the Struggle for Recovery
Nelson, C. A. (2014) · doi:10.4159/harvard.9780674726079 · Cited by 222 · 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-citationHow Early Experience Shapes Human Development: The Case of Psychosocial Deprivation
Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2019) · Neural Plasticity · doi:10.1155/2019/1676285 · Cited by 178 · see citing works
Self-citationBehavioral and emotional symptoms of post-institutionalized children in middle childhood
Wiik, K. L., Loman, M. M., Van Ryzin, M. J., Armstrong, J. M., Essex, M. J., Pollak, S. D., & Gunnar, M. R. (2011) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2010.02294.x · Cited by 161 · see citing works
Postinstitutionalized Children’s Development: Growth, Cognitive, and Language Outcomes
Loman, M. M., Wiik, K. L., Frenn, K. A., Pollak, S. D., & Gunnar, M. R. (2009) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3181b1fd08 · Cited by 144 · see citing works
Vanderwert, 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-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
Rutter, M. L., Kumsta, R., Schlotz, W., & Sonuga-Barke, E. J. S. (2012) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2012.05.011 · Cited by 84 · see citing works
The Ethics of International Research with Abandoned Children
Millum, J., & Emanuel, E. J. (2007) · Science · doi:10.1126/science.1153822 · Cited by 75 · cited 1× · see citing works
“These have been discussed in detail elsewhere (Miller, 2009; Millum & Emanuel, 2007; Nelson et al., 2014; Rid, 2012; Zeanah, Fox, & Nelson, 2012).”
BackgroundThe 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-citationAlmas, A. N., Degnan, K. A., Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2016) · Developmental Psychology · doi:10.1037/dev0000167 · Cited by 63 · cited 2× · see citing works
“Furthermore, investigations into potential mechanisms by which experience can foster adaptive functioning may consider cognitive ability (Almas et al., 2016) and/or adaptive mounting of the stress response system (McLaughlin et al.”
BackgroundSelf-citationDrury, S. S., Theall, K. P., Smyke, A. T., Keats, B. J. B., EGGER, H. L., Nelson, C. A., Fox, N. A., Marshall, P. J., & Zeanah, C. H. (2010) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2009.09.021 · Cited by 52 · see citing works
Self-citationMiddle School Youth Risk Behavior Survey, 2005
Kann, L. K., Brener, N. D., & Shanklin, S. L. (2007) · Cited by 49 · see citing works
Brett, Z. H., Humphreys, K. L., Smyke, A. T., Gleason, M. M., Nelson, C. A., Zeanah, C. H., Fox, N. A., & Drury, S. S. (2015) · Development and Psychopathology · doi:10.1017/s0954579414001266 · Cited by 42 · see citing works
Self-citationAlmas, A. N., Papp, L. J., Woodbury, M. R., Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2018) · Child Development · doi:10.1111/cdev.13169 · Cited by 38 · see citing works
Self-citationMoran, L. R., Lengua, L. J., Zalewski, M., Ruberry, E. J., Klein, M. R., Thompson, S. F., & Kiff, C. J. (2016) · Journal of Research in Personality · doi:10.1016/j.jrp.2016.03.003 · Cited by 37 · see citing works
The 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
Resilience as the Millennium Rorschach: Response to Smith and Gorell Barnes
Rutter, M. L. (1999) · Journal of Family Therapy · doi:10.1111/1467-6427.00111 · Cited by 23 · see citing works
Vulnerability and resilience after early institutional care: The Greek Metera study
Vorria, P., Ntouma, M., & Rutter, M. (2015) · Development and Psychopathology · doi:10.1017/s0954579415000243 · Cited by 19 · see citing works
Humphreys, K. L., Zeanah, C. H., Nelson, C. A., Fox, N. A., & Drury, S. S. (2015) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000171 · Cited by 18 · see citing works
Self-citationA neurogenetics approach to defining differential susceptibility to institutional care
Brett, Z. H., Sheridan, M. A., Humphreys, K., Smyke, A. T., Gleason, M. M., Fox, N. A., Zeanah, C. H., Nelson, C. A., & Drury, S. S. (2014) · International Journal of Behavioral Development · doi:10.1177/0165025414538557 · Cited by 15 · see citing works
Self-citationRid, A. (2012) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e318247d124 · Cited by 13 · cited 1× · see citing works
“These have been discussed in detail elsewhere (Miller, 2009; Millum & Emanuel, 2007; Nelson et al., 2014; Rid, 2012; Zeanah, Fox, & Nelson, 2012).”
Background
Flagged first, then by citations
Research works printed but not linked: 2
- Gresham F.M., 1990, Social skills rating system (SSRS)
- 10.1111/j.1540-5834.2010.00548.x · DOI
Cited by
Sorted by citations
The neglect–enrichment continuum: Characterizing variation in early caregiving environments
King, L. S., Humphreys, K. L., & Gotlib, I. H. (2019) · Developmental Review · doi:10.1016/j.dr.2019.01.001 · Cited by 58 · see citing works
Self-citationHumphreys, K. L., Guyon-Harris, K. L., Tibu, F., Wade, M., Nelson, C. A., Fox, N. A., & Zeanah, C. H. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000613 · Cited by 26 · see citing works
Self-citationResidential care as an alternative care option: A review of literature within a global context
Giraldi, M., Mitchell, F., Porter, R. B., Reed, D., Jans, V., McIver, L., Manole, M., & McTier, A. (2022) · Child & Family Social Work · doi:10.1111/cfs.12929 · Cited by 18 · see citing works
Guyon-Harris, K. L., Humphreys, K. L., Miron, D., Tibu, F., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2021) · Development and Psychopathology · doi:10.1017/s0954579419001500 · Cited by 8 · see citing works
Self-citationHare, M. M., Humphreys, K. L., Cosmoiu, A., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2026) · Developmental Psychology · doi:10.1037/dev0002029 · Cited by 1 · see citing works
Self-citationHolt-Gosselin, B., Adri, F., Humphreys, K. L., & Nelson, C. A. (2026) · Development and Psychopathology · doi:10.1017/s0954579426101837
“…Humphreys et al., 2017; King et al., 2023; Smyke et al., 2012), as well as improved peer relationships, social functioning (Almas et al., 2015; Humphreys et al., 2018; Levin et al., 2015; Wade et al., 2020b) and adaptive functioning (Hare et al., 2026; Humphreys et al., 2018) compared to CAUG.”
Self-citation
- Authors
- Humphreys, K. L., Miron, D., McLaughlin, K. A., Sheridan, M. A., Nelson, C. A., Fox, N. A., & Zeanah, C. H.
- Affiliations
- Tulane University (US)
- University of Washington (US)
- University of North Carolina at Chapel Hill (US)
- Boston Children's Hospital (US)
- University of Maryland, College Park (US)
- Corresponding author
- Humphreys, Kathryn L.
- ORCID
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2018-02
- Volume
- 59
- Issue
- 7
- Pages
- 811-821
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- PMC
- PMC6214343
- OpenAlex
- W2790801371
- Semantic Scholar
- 2dc16404195ed58e3d47542cf22893234b04efac
- Cited by
- 44
- References
- 47
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 9 · 2019: 4 · 2018: 5 · 2017: 1
- FWCI
- 11.46
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- National Institute of Mental Health (MH091363)
- John D. and Catherine T. MacArthur Foundation
- Topics
- Social Sciences › Safety Research › Child Welfare and Adoption
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Education › Early Childhood Education and Development
- Keywords
- foster care, institutional care, early childhood deprivation, adaptive behavior, early adolescence, Bucharest Early Intervention Project, abandoned infants, family placement, stress responsivity, IQ, mental health, substance use, risk-taking, peer relationships, academic performance
- MeSH terms
- Adaptation, Psychological, Adolescent, Child, Child Behavior, Child, Institutionalized, Child, Preschool, Female, Follow-Up Studies, Foster Home Care, Humans, Infant, Intelligence, Male, Psychosocial Deprivation, Romania, Stress, Physiological, Social Skills
About these checks
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.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
