The Ethics of International Research with Abandoned Children

Millum, Joseph; Emanuel, Ezekiel J.

doi:10.1126/science.1153822

Cited by 75Ethics in Clinical ResearchEthics and bioethics in healthcareChild Welfare and Adoption

The Ethics of International Research with Abandoned Children

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Millum, Joseph, Emanuel, Ezekiel J.·2007·Science

DOI 10.1126/science.1153822

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Placement decisions were made by the Romanian child protection system; the BEIP team did not have authority to control placement decisions, did not interfere with those decisions, and did not withhold treatment.
“Placement decisions (including foster care or adoption) were made by the Romanian child protection system; thus, the BEIP team did not have authority to control placement decisions and did not interfere with those decisions, nor did they withhold treatment (Millum & Emanuel, 2007).”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Millum & Emanuel, 2007
In “Guarding Against Exploitation” (page not available), the paper says the state was responsible for the children and that BEIP researchers were not responsible for Romania’s institutionalization of them. In “The Ethics of the BEIP Study” (page not available), it says no child was put at additional risk to obtain the results. Our copy does not establish who made individual foster-care or adoption placements, whether the team lacked authority or refrained from interfering, or whether it withheld treatment. (LLM, conf=0.82)
Experimental — accuracy not yet measured
The BEIP incorporated extensive ethical oversight and safeguards appropriate for this vulnerable population.
“The BEIP incorporated extensive ethical oversight and safeguards appropriate for this vulnerable population (Millum & Emanuel, 2007).”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Millum & Emanuel, 2007
In “The Ethics of the BEIP Study” (page not specified), the authors discuss safeguards for children unable to consent and say the BEIP’s assessments were unlikely to harm them. “Guarding Against Exploitation” (page not specified) describes the researchers’ prompt communication of results to those able to act on them. Our copy does not establish that the BEIP had extensive ethical oversight, so that part of the claim is unsupported. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Extensive ethical review concluded that study participation was unlikely to impose net harm to children, while offering the possibility of substantial direct and societal benefit.
“Extensive ethical review concluded that study participation was unlikely to impose net harm to children, while offering the possibility of substantial direct and societal benefit (Millum & Emanuel, 2007).”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Millum & Emanuel, 2007
The ethics of BEIP have been discussed in detail by the principal investigators and ethics experts.
“The ethics of BEIP have been discussed in detail by the principal investigators of the BEIP as well as ethics experts (Millum & Emanuel, 2007;”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Millum & Emanuel, 2007

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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
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We thank C. Grady, F. Miller, G. Persad, A. Schulz-Baldes, D. Wendler, and A. Wertheimer. The opinions expressed are the authors' own. They do not reflect any position or policy of the National Institutes of Health, U.S. Public Health Service, or Department of Health and Human Services. 10.1126/science.1153822 www.sciencemag.org SCIENCE VOL 318 21 DECEMBER 2007 · DOI

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“For discussion of ethical issues and safeguards related to the BEIP see Millum and Emanuel (2007), Wassenaar (2006) and Zeanah et al. (2006).”
Background
Placement 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
“Ethical issues involving this vulnerable population have been discussed in detail elsewhere (Millum & Emanuel, 2007; Nelson et al., 2007; Wassenaar, 2006; Zeanah et al., 2006).”
Timing of intervention affects brain electrical activity in children exposed to severe psychosocial neglect
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
“Written informed consent was obtained from each of the 6 local Commissions for Child Protection in Bucharest and/or the biological parents when possible (for detailed discussions of the ethical considerations see [20–22]).”
Method
Effects of institutional rearing and foster care on psychopathology at age 12 years in Romania: follow-up of an open, randomised controlled trial
Humphreys, 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
A Randomized Controlled Trial Comparing Foster Care and Institutional Care for Children With Signs of Reactive Attachment Disorder
Smyke, 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
Effects of early intervention on EEG power and coherence in previously institutionalized children in Romania
Marshall, P. J., Reeb, B. C., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2008) · Development and Psychopathology · doi:10.1017/s0954579408000412 · Cited by 175 · see citing works
“See Millum & Emanuel (2007), Wassenaar (2006), and Zeanah et al. (2006) for more detailed discussions of related ethical issues and safeguards.”
Attachment security as a mechanism linking foster care placement to improved mental health outcomes in previously institutionalized children
McLaughlin, 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
“A complete description of procedures employed to ensure ethical integrity has been published previously (Miller, 2009; Millum & Emanuel, 2007; Zeanah et al., 2006).”
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
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How 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
“(For discussion of the ethical issues the BEIP investigators faced, see [98, 99].”
Delayed maturation in brain electrical activity partially explains the association between early environmental deprivation and symptoms of attention-deficit/hyperactivity disorder
McLaughlin, K. A., Fox, N. A., Zeanah, C. H., Sheridan, M. A., Marshall, P., & Nelson, C. A. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.04.005 · Cited by 144 · see citing works
Growth and associations between auxology, caregiving environment, and cognition in socially deprived Romanian children randomized to foster vs ongoing institutional care
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“The rationale behind the study, justification and critique of the randomized controlled design, and the approval process and procedures put in place to safeguard these children have been discussed in depth in previous publications.(18,27,38-40) Approval was obtained from the institutional review boards of the home ins…”
Background
Normalization of EEG activity among previously institutionalized children placed into foster care: A 12-year follow-up of the Bucharest Early Intervention Project
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
“…use of institutional care for abandoned or orphaned infants nd children has remained a common practice throughout the orld (Browne et al., 2006; UNICEF, 2015); however, institutional nvironments are harmful for healthy physical and psychological evelopment especially for young children.”
Genetic sensitivity to the caregiving context: The influence of 5httlpr and BDNF val66met on indiscriminate social behavior
Drury, S. S., Gleason, M. M., Theall, K. P., Smyke, A. T., Nelson, C. A., Fox, N. A., & Zeanah, C. H. (2011) · Physiology & Behavior · doi:10.1016/j.physbeh.2011.11.014 · Cited by 115 · see citing works
“Ethical issues in this study are numerous and complex because of the extremely vulnerable population, have been discussed by us [54] and by others [55,56] in detail elsewhere.”
Alternatives for abandoned children: Insights from the Bucharest Early Intervention Project
Zeanah, C. H., Humphreys, K. L., Fox, N. A., & Nelson, C. A. (2017) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2017.02.024 · Cited by 115 · see citing works
The Effects of Early Experience on Face Recognition: An Event-Related Potential Study of Institutionalized Children in Romania
Moulson, M. C., Westerlund, A., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2009) · Child Development · doi:10.1111/j.1467-8624.2009.01315.x · Cited by 110 · see citing works
“Although the ethical issues raised by this project have been given appropriate consideration elsewhere (Millum & Emanuel, 2007; Zeanah et al., 2006a, 2006b), it is important to address two points regarding children's placement into caregiving environments during the course of the study.”
Adverse Rearing Environments and Neural Development in Children: The Development of Frontal Electroencephalogram Asymmetry
McLaughlin, K. A., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2011) · Biological Psychiatry · doi:10.1016/j.biopsych.2011.08.006 · Cited by 108 · see citing works
Early experience and brain development
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Long-term effects of institutional rearing, foster care, and brain activity on memory and executive functioning
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
“The present study examined data from the BEIP, the details and ethical issues of which have been discussed previously (16, 42).”
Method
Interventions in Foster Family Care: A Systematic Review
Bergström, M., Cederblad, M., Håkansson, K., Jonsson, A. K., Munthe, C., Vinnerljung, B., Wirtberg, I., Östlund, P., & Sundell, K. (2020) · Research on Social Work Practice · doi:10.1177/1049731519832101 · Cited by 90 · see citing works
“Further, ethical aspects of research regarding children (Millum & Emanuel, 2007), and uncertainty motivating research (Munthe, 2016), were included.”
Background
Effect of Foster Care Intervention on Trajectories of General and Specific Psychopathology Among Children With Histories of Institutional Rearing: A Randomized Clinical Trial
Wade, 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
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
Signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years: effects of institutional care history and high-quality foster care
Humphreys, 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
“We and others have previously written about the ethical dimensions of the study (Miller, 2009; Millum & Emanuel, 2007; Zeanah et al., 2006; Zeanah, Fox, & Nelson, 2012).”
Background
The effects of foster care intervention on socially deprived institutionalized children’s attention and positive affect: results from the BEIP study
Ghera, M. M., Marshall, P. J., Fox, N. A., Zeanah, C. H., Nelson, C. A., Smyke, A. T., & Guthrie, D. (2009) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2008.01954.x · Cited by 96 · see citing works
“Ethical safeguards of the BEIP have been discussed in detail elsewhere (Millum & Emanuel, 2007; Wassenaar, 2006; Zeanah et al., 2003, 2006).”
IQ at age 12 following a history of institutional care: findings from the Bucharest Early Intervention Project
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
“Throughout the course of the project, ethical concerns and considerations have been discussed in detail (Millum & Emanuel, 2007; Nelson et al., 2014; Zeanah et al., 2012).”
Background
Early deprivation, atypical brain development, and internalizing symptoms in late childhood
Bick, J. R., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2015) · Neuroscience · doi:10.1016/j.neuroscience.2015.09.026 · Cited by 72 · see citing works
“Additional safeguards, protections, and considerations related to conducting research with this specific sample of children have been discussed previously (Wassenaar, 2006; Zeanah et al., 2006; Millum and Emanuel, 2007; Nelson et al., 2007).”
Background
Biological perspectives on the effects of early psychosocial experience
Marshall, P. J., & Kenney, J. W. (2009) · Developmental Review · doi:10.1016/j.dr.2009.05.001 · Cited by 47 · see citing works
Caregiving disruptions affect growth and pubertal development in early adolescence in institutionalized and fostered Romanian children: A randomized clinical trial
Johnson, D. E., Tang, A., Almas, A. N., Degnan, K. A., McLaughlin, K. A., Nelson, C. A., Fox, N. A., Zeanah, C. H., & Drury, S. S. (2018) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2018.07.027 · Cited by 49 · see citing works
“Randomization was implemented by assigning each child a number (1-136) written on a piece of paper, which were then placed in a hat and then drawn at random.”
Alterations in Neural Processing and Psychopathology in Children Raised in Institutions
Slopen, N., McLaughlin, K. A., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2012) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2012.444 · Cited by 46 · see citing works
Foster care promotes adaptive functioning in early adolescence among children who experienced severe, early deprivation
Humphreys, K. L., Miron, D., McLaughlin, K. A., Sheridan, M. A., Nelson, C. A., Fox, N. A., & Zeanah, C. H. (2018) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12865 · Cited by 44 · 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
Serotonin transporter linked polymorphic region (5-HTTLPR) genotype moderates the longitudinal impact of early caregiving on externalizing behavior
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
“Greater detail about the ethical issues and study design are described elsewhere (Millum & Emanuel, 2007; Nelson et al., 2014; Zeanah, Fox, & Nelson, 2012; Zeanah et al., 2003).”
Background
High-quality foster care mitigates callous-unemotional traits following early deprivation in boys: a Randomized Controlled Trial
Humphreys, 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
“22,23”
Method
Course of Disinhibited Social Engagement Disorder From Early Childhood to Early Adolescence
Guyon-Harris, K. L., Humphreys, K. L., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2018) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2018.02.009 · Cited by 37 · see citing works
Using cross-species comparisons and a neurobiological framework to understand early social deprivation effects on behavioral development
Brett, Z. H., Humphreys, K. L., Fleming, A. S., Kraemer, G. W., & Drury, S. S. (2015) · Development and Psychopathology · doi:10.1017/s0954579415000036 · Cited by 39 · see citing works
“The study of institutionalized children, such as those in the BEIP, raises ethical issues (Miller, 2009; Millum & Emanuel, 2007; Zeanah, Fox, & Nelson, 2012; Zeanah et al., 2006).”
Background
Foster care leads to sustained cognitive gains following severe early deprivation
Humphreys, K. L., King, L. S., Guyon-Harris, K. L., Sheridan, M. A., McLaughlin, K. A., Radulescu, A., Nelson, C. A., Fox, N. A., & Zeanah, C. H. (2022) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2119318119 · Cited by 36 · see citing works
Signs of attachment disorders and social functioning among early adolescents with a history of institutional care
Guyon‐Harris, K. L., Humphreys, K. L., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2018) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2018.11.005 · Cited by 48 · see citing works
A Comprehensive Multilevel Analysis of the Bucharest Early Intervention Project: Causal Effects on Recovery From Early Severe Deprivation
King, 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
“After randomization to foster careor to care as usual, children were assessed across multiple developmental domains at baseline and at ages 30, 42, and 54months (at which point the trial concluded and support of the foster care network was transferred to the Romanian authorities) (11).”
Method
Ethical challenges in research with orphans and vulnerable children: a qualitative study of researcher experiences.
Kelley, M., Brazg, T., Wilfond, B., Lengua, L. J., Rivin, B., Martin-Herz, S., & Diekema, D. (2016) · International Health · doi:10.1093/inthealth/ihw020 · Cited by 30
A prospective longitudinal study of Reactive Attachment Disorder following early institutional care: considering variable- and person-centered approaches
Guyon‐Harris, K. L., Humphreys, K. L., Degnan, K. A., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2018) · Attachment & Human Development · doi:10.1080/14616734.2018.1499208 · Cited by 38 · see citing works
“Ethical considerations of the study have been discussed previously in some detail by us and by others (Miller, 2009; Millum & Emanuel, 2007; Nelson et al., 2014; Rid, 2012; Zeanah, Fox, & Nelson, 2012).”
Impact of early institutionalization on attention mechanisms underlying the inhibition of a planned action
Lamm, C., Troller‐Renfree, S. V., Zeanah, C. H., Nelson, C. A., & Fox, N. A. (2018) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2018.06.008 · Cited by 34 · see citing works
“, 2006a,2006b, 2012) and by others (Miller, 2009; Millum and Emanuel, 2007; Rid, 2012).”
Cultural considerations for informed consent in paediatric research in low/middle-income countries: a scoping review
Colom, M., & Rohloff, P. (2018) · BMJ Paediatrics Open · doi:10.1136/bmjpo-2018-000298 · Cited by 27
A 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
“Ethical issues have been discussed by the present authors (Zeanah, Fox, & Nelson, 2012; Zeanah et al., 2006), and others (Miller, 2009; Millum & Emanuel, 2007).”
Background
Psychiatric outcomes following severe deprivation in early childhood: Follow-up of a randomized controlled trial at age 16.
Humphreys, 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
“Ethical considerations are discussed in detail elsewhere (Millum & Emanuel, 2007; Zeanah, Fox, & Nelson, 2012).”
Background
PSYCHOPATHOLOGY IN YOUNG CHILDREN IN TWO TYPES OF FOSTER CARE FOLLOWING INSTITUTIONAL REARING
Tibu, F., Humphreys, K. L., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2014) · Infant Mental Health Journal · doi:10.1002/imhj.21428 · Cited by 23 · see citing works
“Ethical issues have been discussed previously in some detail by us (Zeanah, Fox, & Nelson, 2012; Zeanah et al., 2006) and by others (Miller, 2009; Millum & Emanuel, 2007).”
Background
Resting brain activity in early childhood predicts IQ at 18 years
Tan, E., Tang, A., Debnath, R., Humphreys, K. L., Zeanah, C. H., Nelson, C. A., & Fox, N. A. (2023) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2023.101287 · Cited by 22 · see citing works
“The ethical issues of the BEIP study have been previously discussed (Millum and Emanuel, 2007; Wassenaar, 2006; Zeanah et al., 2006).”
The consequences of foster care versus institutional care in early childhood on adolescent cardiometabolic and immune markers: Results from a randomized controlled trial
Slopen, 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
Coordinated and evidence-based policy and practice for protecting children outside of family care
Boothby, N., Balster, R. L., Goldman, P., Wessells, M., Zeanah, C. H., Huebner, G., & Garbarino, J. (2012) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2012.09.007 · Cited by 17 · see citing works
Serotonin Transporter Genotype (5HTTLPR) Moderates the Longitudinal Impact of Atypical Attachment on Externalizing Behavior
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
Neuroscience, Embodiment, and Development
Marshall, P. J. (2015) · Wiley eBooks · doi:10.1002/9781118963418.childpsy107 · Cited by 20 · see citing works
Psychosocial deprivation and receptive language ability: a two-sample study
Humphreys, K. L., Machlin, L., Guyon‐Harris, K. L., Nelson, C. A., Fox, N. A., & Zeanah, C. H. (2020) · Journal of Neurodevelopmental Disorders · doi:10.1186/s11689-020-09341-2 · Cited by 12 · see citing works
“Ethical considerations are discussed in detail elsewhere [38, 61].”
Background
Psychopathology Following Severe Deprivation: History, Research, and Implications of the Bucharest Early Intervention Project
Humphreys, K. L., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2017) · Springer eBooks · doi:10.1007/978-3-319-57990-0_6 · Cited by 16 · see citing works
Use of Residential Care in Europe for Children Aged Under Three: Some Lessons from Neurobiology
Bilson, A. (2009) · British Journal of Social Work · doi:10.1093/bjsw/bcp076 · Cited by 12 · see citing works
“Development and psychopathology 20(3):861- 80 Millum, J. and Emmanuel E. J. (2007) ‘The Ethics of International Research with Abandoned Children’ Science 318 pp. 1874-1875 Morison, S. J., Ames, E. W., and Chisholm, K. (1995) ‘The development of children adopted from Romanian orphanages.’”
Background
Growth in Self-Regulation Over the Course of Adolescence Mediates the Effects of Foster Care on Psychopathology in Previously Institutionalized Children: A Randomized Clinical Trial
Mukerji, C., Wade, M., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2021) · Clinical Psychological Science · doi:10.1177/2167702621993887 · Cited by 13 · see citing works
Family-based care buffers the stress sensitizing effect of early deprivation on executive functioning difficulties in adolescence
Wade, M., McLaughlin, K. A., Buzzell, G. A., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2023) · Child Development · doi:10.1111/cdev.13863 · Cited by 12 · see citing works
Associations between Early Psychosocial Deprivation, Cognitive and Psychiatric Morbidity, and Risk-taking Behavior in Adolescence
Wade, M., Carroll, D., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2021) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2020.1864737 · Cited by 15 · see citing works
“Details about the sample and ethical considerations are available elsewhere (Millum & Emanuel, 2007).”
Background
COVID-19 vaccine trials with children: ethics pointers
Atuire, C., Salas, S. P., Wright, K., Ambe, J., & de Vries, J. (2022) · BMJ Global Health · doi:10.1136/bmjgh-2021-007466 · Cited by 9
Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation
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
Preventing Inequity in International Research
Rudan, I. (2008) · Science · doi:10.1126/science.319.5868.1336a · Cited by 8
The Effects of Early Psychosocial Deprivation on Brain and Behavioral Development: Findings from the Bucharest Early Intervention Project
Nelson, C. A., Fox, N. A., & Zeanah, C. H. (2016) · Wiley eBooks · doi:10.1002/9781119125556.devpsy418 · Cited by 4 · see citing works
Ethical challenges for the design and conduct of mega-biobanking from Great East Japan Earthquake victims
Matsui, K., & Tashiro, S. (2014) · BMC Medical Ethics · doi:10.1186/1472-6939-15-55 · Cited by 6
“Rather, if there is good reason to believe that the balance between burdens and potential benefits seems sufficient, it may be considered as fair research [45].”
Background
Results Reporting and Early Termination of Childhood Obesity Trials Registered on ClinicalTrials.gov
Wang, X., Long, Y., Liu, Y., Huang, J., & Du, L. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.860610 · Cited by 5 · see citing works
Disinhibited Social Engagement Disorder in Early Childhood Predicts Reduced Competence in Early Adolescence
Guyon‐Harris, K. L., Humphreys, K. L., Miron, D., Gleason, M. M., Nelson, C. A., Fox, N. A., & Zeanah, C. H. (2019) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-019-00547-0 · Cited by 12 · see citing works
“Ethical dimensions of the study have been discussed by us and others in detail elsewhere (Miller 2009; Millum and Emanuel 2007; Nelson et al. 2014; Zeanah et al. 2012).”
Method
Foster Care Leads to Lower Irritability Among Adolescents with a History of Early Psychosocial Deprivation
Niu, Y., Buzzell, G. A., Cosmoiu, A., Fox, N. A., Nelson, C. A., Zeanah, C. H., & Humphreys, K. L. (2024) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-024-01193-x · Cited by 6 · see citing works
“Consistent with prior BEIP studies (see Zeanah et al., 2009 ), we used an intent-to-treat (ITT) analysis approach, in which ethics of the study have been widely discussed (Millum & Emanuel, 2007 ; Miller, 2009 ; Rid 2012 ; Zeanah et al., 2006 , 2012 ).”
Method
Ethical Considerations in Global Mental Health Research
Loue, S. (2021) · Springer eBooks · doi:10.1007/978-3-030-66296-7_4 · Cited by 3 · see citing works
Exploring Background Aperiodic Electroencephalography (EEG) Activity in the Bucharest Early Intervention Project
Antúnez, M., McSweeney, M., Zeytinoglu, S., Tan, E., Zeanah, C., Nelson, C. A., & Fox, N. A. (2024) · Developmental Psychology · doi:10.1037/dev0001804 · Cited by 2
“Ethical considerations of the BEIP study have been previously discussed by our team and by bioethicists (F. G. Miller, 2009; Millum & Emanuel, 2007; C. A. Nelson et al., 2014; Rid, 2012; Zeanah et al., 2012) because of the vulnerability of the study population and because of special issues involved…”
Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project
Mens, M. M. J., Jopling, E., Hare, M., Drury, S. S., Nelson, C. A., Zeanah, C. H., Fox, N. A., & Slopen, N. (2026) · Development and Psychopathology · doi:10.1017/s0954579426101540 · Cited by 1 · see citing works
Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project
Holt-Gosselin, B., Adri, F., Humphreys, K. L., & Nelson, C. A. (2026) · Development and Psychopathology · doi:10.1017/s0954579426101837
“The BEIP incorporated extensive ethical oversight and safe-guards appropriate for this vulnerable population (Millum & Emanuel, 2007).”
Influential
Confronting ethical permissibility in animal research: rejecting a common assumption and extending a principle of justice
Choe-Smith, C. (2014) · Theoretical Medicine and Bioethics · doi:10.1007/s11017-014-9290-8
Rethinking cardiometabolic risk: The role of childhood neglect and biomarker decoupling
Jopling, E. N., Mens, M. M. J., Hare, M. M., Drury, S. S., Fox, N. A., Nelson, C. A., Zeanah, C. H., & Slopen, N. B. (2026) · Annals of Epidemiology · doi:10.1016/j.annepidem.2026.110201
Globalisation des essais cliniques pédiatriques et contexte de vulnérabilité : un risque nécessaire !
Dahane, N., & Godard, B. (2020) · Droit Santé et Société · doi:10.3917/dsso.065.0049
Incitation indue et recherche en contexte de difficulté d’accès aux soins : où mettre le curseur ?
Dahane, N., & Godard, B. (2020) · doi:10.1016/j.etiqe.2020.04.008
Addressing Research Ethics in Clinical Trials in Four of the Former Communist European Countries
Macarie, G., & Tebeanu, A. V. (2019) · Advances in Library and Information Science · doi:10.4018/978-1-5225-6310-5.ch007
The epigenetic impacts of pubertal acceleration following early caregiver disruptions
Jopling, E., Drury, S. S., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2025) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2504216122 · Cited by 2
“Details regarding the sample, inclusion and exclusion criteria, historical background, and ethical considerations have been detailed elsewhere (45, 46).”

Authors: Millum, J., & Emanuel, E. J.
Affiliations: National Institutes of Health (US)
Corresponding author: Emanuel, Ezekiel J.
ORCID: Millum, Joseph
Venue: Science
Publisher: American Association for the Advancement of Science (AAAS)
Published: 2007-12-21
Volume: 318
Issue: 5858
Pages: 1874-1875
ISSN: 0036-8075 (ISSN-L)
1095-9203
DOI: 10.1126/science.1153822
OpenAlex: W1620096738
Cited by: 75
References: 0
Citations by year: 2026: 3 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 3 · 2020: 5 · 2019: 5 · 2018: 10 · 2017: 3 · 2016: 4 · 2015: 9 · 2014: 4 · 2012: 5
Type: journal article
Language: en
Open access: green
philpapers.org
Locations: Science (publishedVersion)
PubMed (publishedVersion)
PhilPapers (PhilPapers Foundation) (submittedVersion)
Funders: National Institutes of Health (Z99CL999999)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Social Sciences › Safety Research › Child Welfare and Adoption
Keywords: research ethics, international research, abandoned children, child welfare, research with vulnerable populations
MeSH terms: Child, Child, Abandoned, Child, Institutionalized, Child, Preschool, Foster Home Care, Humans, Infant, Informed Consent, Romania, Randomized Controlled Trials as Topic, Early Intervention, Educational, Bioethical Issues, Ethics, Research, Internationality

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The Ethics of International Research with Abandoned Children

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