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Cited by 30Child Welfare and AdoptionChild Abuse and TraumaEarly Childhood Education and Development

A Comprehensive Multilevel Analysis of the Bucharest Early Intervention Project: Causal Effects on Recovery From Early Severe Deprivation

Open access
King, Lucy S., Guyon-Harris, Katherine L., Valadez, Emilio A., Radulescu, Anca, Fox, Nathan A., Nelson, Charles A., Zeanah, Charles H., Humphreys, Kathryn L.·2023·American Journal of Psychiatry
DOI 10.1176/appi.ajp.20220672PMC PMC10751847
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Abstract

OBJECTIVE: The Bucharest Early Intervention Project is the first randomized controlled trial of foster care as an alternative to institutional care. The authors synthesized data from nearly 20 years of assessments of the trial to determine the overall intervention effect size across time points and developmental domains. The goal was to quantify the overall effect of the foster care intervention on children's outcomes and examine sources of variation in this effect, including domain, age, and sex assigned at birth. METHODS: An intent-to-treat approach was used to examine the causal effects of the randomized controlled trial for 136 children residing in institutions in Bucharest, Romania (baseline age, 6-31 months) who were randomly assigned to either foster care (N=68) or care as usual (N=68). At ages 30, 42, and 54 months and 8, 12, and 16-18 years, children were assessed for IQ, physical growth, brain electrical activity (EEG), and symptoms of five types of psychopathology. RESULTS: Participants provided 7,088 observations across follow-up waves. Children assigned to foster care had better cognitive and physical outcomes and less severe psychopathology than did those who received care as usual. The magnitude of these effect sizes remained stable across development. The foster care intervention most influenced IQ and disorders of attachment/social relatedness. CONCLUSIONS: Young children benefit from placement in families after institutional care. The benefits of foster care for previously institutionalized children were remarkably stable across development.

Integrity signals

Registry

Crossref · 10.1176/appi.ajp.20220672

Cites

50 of 50 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

24 of 39 cited sources checked · 14 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Psychosocial deprivation in both institutional and family-based contexts is linked to delays in cognitive, physical, and socioemotional development.

    “Given that psychosocial deprivation both in institutional and family-based contexts is linked to delays in cognitive, physical, and socioemotional development (2,(4)(5)(6), understanding the impact of interventions that aim to promote recovery from early neglect is a public health priority.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [2] source

      The Meta-analytical results section (page not available in our copy) links institutional care to delays in physical growth and cognition and to smaller differences in socioemotional development. Its comparisons with children in family care do not establish that psychosocial deprivation within family-based settings is linked to those delays, so the family-based part of the claim is not supported by this paper. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [4] source
    • cites [5] source

      The Discussion (Plausibility; page unavailable) says early maltreatment can negatively affect physical, cognitive, emotional, and social growth. The Introduction defines neglect in terms of care by a parent or family member. Our copy does not establish the claimed link for psychosocial deprivation in institutional settings. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    Using a common analytic approach across multiple informants, time points, and developmental domains can address concerns about the robustness of scientific findings.

    “By using a common approach to analyze data from multiple informants, time points, and developmental domains, we can address concerns about the robustness of scientific findings (20,21).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [20] source

      The introduction (page not supplied) links improved statistical analysis, assessment of analytic choices, and aggregation across datasets to more reliable and robust findings. It does not discuss applying one common approach across multiple informants, time points, and developmental domains; its references to domains concern cognitive and affective neuroscience, not developmental domains. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [21] source

      The Robustness section supports the general concern that findings may depend on analytic choices. But the definitions section distinguishes robustness—testing the same data with different analyses—from replication using different data. The paper does not specifically recommend a common analytic approach across informants, time points, and developmental domains. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    Examining outcomes after placement in family-based care increases knowledge about developmental plasticity, including how much lasting improvement after early deprivation is possible.

    “Specifically, examining children's outcomes following placement in familybased care enhances knowledge of developmental plasticity, including the degree to which lasting improvement following early deprivation is possible (8).”
    Quote in the paperSubstantial claim1 of 1 sources checked
  • Findingown data

    The intervention showed a sleeper effect on externalizing problems, matching previous analyses.

    “Instead, with the exception of externalizing problems for which we observed a sleeper effect consistent with previous analyses in subsets of these data (17,43), we found that the benefits of foster care were similar throughout development.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [17] source

      The Introduction reports no foster-care effect on externalising symptoms at 54 months, while the age-12 Findings report fewer externalising symptoms in the foster-care group. The Discussion says this later finding *might* represent a sleeper effect, rather than establishing that it did. Our copy also does not establish the claimed consistency with previous analyses of subsets of these data. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [43] source
  • Findingown data

    Except for externalizing problems, the benefits of foster care remained similar throughout development.

    “Instead, with the exception of externalizing problems for which we observed a sleeper effect consistent with previous analyses in subsets of these data (17,43), we found that the benefits of foster care were similar throughout development.”
    Quote in the paperSubstantial claim2 of 2 sources checked
  • Classified as probably not a substantial claim. 21
  • May combine two claims. 28

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Within the foster care group, stability of placement with the original study-sponsored foster family has been previously linked with children's outcomes.

    “Within the foster care group, the stability of placement with the original study-sponsored foster family has been previously linked with children's outcomes (17,22).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [17] source
    • cites [22] source

      The Results section (Stable vs. Disrupted Foster Care Placement; page unavailable) found no statistically significant difference in longitudinal competence between children who stayed with their original foster family and those whose placements were disrupted. The Discussion explicitly says the study failed to find an association between placement stability and longitudinal competence, although it notes a nonsignificant difference that the study may have been underpowered to detect. (LLM, conf=0.86)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Millions of children raised without parents in institutional care experience severe psychosocial deprivation because of high child-to-caregiver ratios and lack of nurturing care.

    “Unfortunately, millions of children being raised without parents experience severe deprivation in the context of institutional care, where high child-to-caregiver ratios and lack of nurturing care lead to psychosocial neglect even when survival needs are met (1,2).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [1] source
    • cites [2] source

  • Classified as probably not a substantial claim.

    Premisecitation

    Studying children's developmental functioning during and after institutional care provides insight into effects of deprivation relevant to neglected children across contexts.

    “Studying children's developmental functioning during and after exposure to institutional care provides insight into the effects of deprivation relevant to neglected children across contexts (7).”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior publications have documented the effects of the foster care intervention across development extensively.

    “The effects of the foster care intervention across development have been documented extensively (e.g., [14][15][16][17][18][19]).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [14] source
      Experimental — accuracy not yet measured
    • cites [15] source
      Experimental — accuracy not yet measured
    • cites [16] source
      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    Differences between the observational studies and the BEIP may stem from the BEIP's experimental design, which controlled for confounders, and from the foster care intervention possibly providing higher quality care than is typical after deinstitutionalization.

    “Differences in findings between these observational studies and the BEIP may be related to the experimental design of the BEIP, which controlled for confounders (e.g., bias in selection of children for deinstitutionalization), and to the foster care intervention possibly delivering higher quality care than is typical following deinstitutionalization (2).”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Early competence can lead to further wellbeing, allowing positive functioning to spread to other domains over time.

    “When viewed through the conceptual lens of developmental cascades, early competence can generate further wellbeing such that positive functioning spreads to other domains over time (41,42).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [41] source
    • cites [42] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The 130 participants provided 7,088 observations across follow-up waves and the domains of cognitive functioning, physical growth, brain electrical activity, and psychopathology.

    “Overall, these 130 participants (48% female) provided 7,088 observations (3,628 foster care; 3,460 care as usual) between the 30-month to 16-to 18-year follow-up waves across the domains of cognitive functioning, physical growth, brain electrical activity, and psychopathology.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The final sample included 136 children who had been abandoned at or shortly after birth and placed in institutions, with a mean baseline age of 20.74 months and 51% female.

    “Thus, the final sample included 136 children (mean age at baseline [range] = 20.74[5.39-31.76]months; 51% female]) who had been abandoned at or shortly after birth and placed in institutions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There were significant intervention effects on IQ (beta = 0.39, 95% CI [0.16, 0.63]) and physical growth (beta = 0.28, 95% CI [0.07, 0.48]) but not on EEG relative alpha power (beta = 0.06, 95% CI [-0.16, 0.29]).

    “There were significant effects of the intervention on IQ (β = 0.39, 95% CI[0.16, 0.63]) and physical growth (β = 0.28, 95% CI[0.07, 0.48]) but not on EEG relative alpha power (β = 0.06, 95% CI[-0.16,0.29]).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The intervention effect on physical size was similar for male and female children, whereas the effect on IQ was larger for female than male children.

    “The effect of the intervention on physical size was similar for male and female children, whereas the effect on IQ was larger for female than male children (see Supplementary Material).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    IQ and disorders of social relatedness were the domains most sensitive to the intervention, with standardized coefficients ranging from .35 to .60.

    “Among these domains, IQ and disorders of social relatedness were most sensitive to the benefits of the intervention (standardized coefficients ranged from .35-.60).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Children in the foster care group had significantly higher average IQ scores and were on average physically larger than children in the care-as-usual group.

    “Children in the foster care group had significantly higher average IQ scores and were, on average, physically larger than were children in the care-as-usual group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Outcome domain and age of assessment each moderated the association between age of placement in foster care and children's cognitive, physical, and neural outcomes.

    “Outcome domain (F[2, 1325.48]= 4.71, p = .009)and age of assessment (F[1, 1354.20]= 5.51, p = .019)each moderated the association between age of placement in foster care and children's cognitive, physical, and neural outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The intervention effect on reactive attachment disorder symptoms was significant throughout development but larger at younger ages than in adolescence.

    “In contrast, the effect of the intervention on reactive attachment disorder symptoms, although significant throughout development, was larger at younger ages than in adolescence (see Supplementary Material).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Neither age of assessment nor sex moderated the effect of the foster care intervention on symptoms of psychopathology in two-way interactions.

    “In two-way interactions, neither age of assessment (F[1, 4261.80]= 2.16, p = .142)nor sex (F[1, 114.50] = 2.37, p = .127)moderated the effect of the foster care intervention on symptoms of psychopathology.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The intervention effects on IQ and physical growth were significantly larger than on EEG alpha power, but there was no significant difference between the effects on IQ and physical growth.

    “The effects of the intervention on IQ and physical growth were significantly larger than on EEG alpha power, but there was no significant difference between the effects on IQ and physical growth (see Supplementary Material).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The intervention effect on externalizing symptoms was close to zero at younger ages but medium in magnitude and significant in adolescence.

    “Whereas effect sizes for disinhibited social engagement disorder, ADHD, and internalizing symptoms were similar across ages of assessment, the effect of the intervention on externalizing symptoms was close to zero at younger ages but medium in magnitude and significant in adolescence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    We did find an association between age of placement into foster care and relative alpha power, suggesting this measure is sensitive to intervention timing.

    “Nonetheless, we did identify an association of age of placement into foster care with relative alpha power, suggesting that this measure is sensitive to the timing of intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Overall, age of placement was associated with children's cognitive, physical, and neural functioning, with earlier placement predicting better outcomes.

    “While there was an overall association of age of placement with children's cognitive, physical, and neural functioning such that children placed earlier fared better, this association depended on the outcome domain.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Psychosocial deprivation is not limited to institutional settings, and neglect is the most common form of maltreatment identified by U.S. Child Protective Services.

    “Furthermore, psychosocial deprivation is not limited to institutions.Neglect is the most common form of maltreatment identified by U.S. Child Protective Services (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Study design and conductcitation

    Children randomized to foster care and care as usual did not differ at baseline on demographic variables, percent of lifetime in institutional care, cognitive functioning, or physical growth.

    “Children randomized to the foster care and care-as-usual groups did not differ on the basis of demographic variables, percent of lifetime in institutional care, cognitive functioning, or physical growth at baseline (Supplementary Table S1; King et al., unpublished 2022 data).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Supplementary Table S1

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites King et al., unpublished 2022 data

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The primary outcomes for the current analyses were cognitive functioning, physical growth, brain electrical activity, and symptoms of five forms of psychopathology.

    “For the current analyses, the primary outcomes were cognitive functioning, physical growth, brain electrical activity, and symptoms of five forms of psychopathology.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Of the 136 participants, 130 completed at least one follow-up assessment.

    “Of the 136 participants, 130 (65 foster care; 65 care as usual) completed at least one of these follow-up assessments.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Assignment to group was done using slips of paper with subject identifiers drawn from a hat, with sibling pairs included together.

    “Assignment to group was done using slips of paper with subject identifiers written on them (sibling pairs included together) and drawn from a hat.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Due to the evolution of child protection efforts in Romania, all but 13 children in the care-as-usual group were placed into family care by the age 18-year assessment wave.

    “Due to the evolution of child protection efforts in Romania, all but 13 children in the care-as-usual group were placed into family care by the age 18-year assessment wave.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Over the follow-up years, many children experienced placement changes, including care-as-usual children receiving family placements, foster care disruptions, and returns to biological families.

    “Notably, over the intervening years, many children experienced placement changes (e.g., many care-as-usual children received family placements; some foster care group children experienced placement disruptions; and some children in each group returned to biological families).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Aggregating data across nearly 20 years of follow-up assessments can provide a more accurate determination of the overall intervention effect size and identify sources of variation in this effect.

    “Consistent with the aims of meta-science techniques like meta-analysis, by aggregating data across nearly 20 years of follow-up assessments, it is possible to provide a more accurate determination of the overall intervention effect size and identify sources of variation in this effect.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Published findings to date largely focus on specific outcomes at discrete timepoints.

  • May combine two claims.

    Study design and conductown data

    The study used an intent-to-treat approach to examine causal effects of the randomized controlled trial for 136 children in Bucharest institutions, baseline age 6-31 months, randomly assigned to foster care (n = 68) or care as usual (n = 68).

    “We used an intent-to-treat approach to examine the causal effects of the RCT for 136 children residing in institutions in Bucharest, Romania (baseline age 6-31 months) randomly assigned to foster care (n = 68) versus care as usual (n = 68).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The study did not adjust for multiple comparisons when testing simple effects of significant interactions, so p-values for simple effects should be interpreted as nominal.

    “Given our goal of characterizing sources of variation in the effect of the foster care intervention, we did not adjust for multiple comparisons when testing simple effects of significant interactions.Thus, p-values for simple effects should be interpreted as nominal.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The BEIP's foster care model encouraged foster parents to make a psychological commitment to the child, unlike the U.S. model that focuses only on instrumental care needs.

    “The model of foster care used in the BEIP (4) encouraged foster parents to make a psychological commitment to the child, thereby differing from the model currently used in the U.S. that emphasizes only instrumental care needs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] source

  • May combine two claims.

    Study design and conductreasoning

    Analyses of sources of variation in outcomes among children in the foster care group are correlational, whereas analyses of intervention group effects may support causal inference.

    “While causality may be inferred from analyses testing the effects of intervention group on children's outcomes, analyses of sources of variation in outcomes among children in the foster care group are correlational in nature.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    These outcomes were chosen because they were assessed consistently across waves, allowing estimation of the overall intervention effect across ages.

    “We chose these outcomes because they were assessed consistently across waves, allowing for estimation of the overall effect of the intervention across ages.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Outcomes varied by developmental domain, by the life stage when children were placed in family-based care, and by whether that care remained stable through childhood and adolescence.

    “Nonetheless, outcomes also differed based on developmental domain, the life stage in which children were placed in familybased care, and whether this care was stable across childhood and adolescence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Lasting group differences likely result from both early exposure to family-based care and the longer-term experiences that exposure set in motion.

    “Lasting group differences are likely both a product of early exposure to family-based care and the longer-term experiences this exposure initialized.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The intervention's impact can be described as rapidly apparent by 30 months and sustained through late adolescence, with little evidence of fadeout.

    “Thus, the impact of the intervention can be described as rapidly apparent by age 30 months and sustained through late adolescence, with minimal evidence of fadeout over time.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Scores on outcome variables were standardized within wave and measure to account for different measures across waves and to put values for different outcomes on the same scale.

    “Prior to all analyses, scores on the outcome variables were standardized within wave and measure to account for the use of different measures across waves and so that values measuring different outcomes were on the same scale.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The analyses preclude examination of growth curves and instead yield information about between-individual differences.

    “Therefore, our analyses preclude examination of growth curves (i.e., within-individual change in outcomes across time) and instead yield information about between-individual differences.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Between-individual differences in effect sizes based on age of assessment must be interpreted relative to the measures used at those ages.

    “Further, between-individual differences in effect sizes based on age of assessment must be interpreted relative to the measures used at those ages.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The later emergence of placement stability's effect is likely related both to more children experiencing disruptions by adolescence and to the harmful consequences of disruptions.

    “The emergence of the effect of placement stability later in development is likely related both to the fact that more children had experienced disruptions by adolescence and that disruptions have harmful consequences (44).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] Fisher PA, 2013, Child Welfare

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Specific features of the institutional or foster care environment in Bucharest at the time of the study may limit generalizability to all such settings worldwide.

    “Further, specific features of the institutional care or foster care environment In Bucharest at the time of the study may limit generalizability to all institutional and foster care settings worldwide.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Foster parents may be more likely than informants for institutionalized children to give positive reports about their children.

    “For example, foster parents may be more likely to provide positive reports of their children than informants for children in institutional care.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    We cannot rule out bidirectional effects between preexisting child characteristics that contributed to placement disruption and the harmful impact of disruptions on child functioning.

    “However, we cannot rule out the possibility of bidirectional effects between preexisting child characteristics that contributed to placement disruption and the harmful role that placement disruptions have on child functioning.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    This fading may occur because later life experiences reduce the potency of earlier events.

    “Specifically, the benefits of earlier placement into foster care were apparent in early childhood but faded out by adolescence, possibly as later life experiences diminished the potency of earlier events.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premiseown data

    By quantitatively synthesizing BEIP data across nearly 20 years of follow-up, this study addresses potential concerns about the robustness of the intervention's effects.

    “By quantitatively synthesizing data from the BEIP across nearly 20 years of follow-up assessments, the current study addresses potential concerns about the robustness of the effects of this intervention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Although the BEIP provides strong causal evidence that family placements benefit children after early institutional care, many questions remain unanswered.

    “Finally, although the BEIP provides firm causal evidence of the benefits of family placements for children following early institutional care, many questions remain unanswered, including fully understanding how aspects of the prenatal, early institutional, and eventual family environments influence recovery.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Because of statistical power concerns for analyses within the foster care group, we did not test three-way interactions for the associations of placement timing and stability with outcomes.

    “Due to concerns regarding statistical power for analyses within the foster care group, we did not test three-way interactions in analyses of the associations of timing and stability of placement with outcomes; thus, we cannot determine whether these associations varied based on the confluence of multiple factors such as domain and development stage.”
    Quote in the paperSubstantial claim
46 of 46

  • The paper relies on this without support.

    Infants require psychosocial care, including nurturance and stimulation, in addition to basic needs, for healthy development.

    “Over and above basic needs like nutrition, shelter, and safety, infants require psychosocial care, including nurturance and stimulation, for healthy development.”

  • The paper relies on this without support.

    Published findings to date largely focus on specific outcomes at discrete timepoints.

    “However, in keeping with scientific conventions, findings published to date largely focus on specific outcomes at discrete timepoints.”

  • The paper relies on this without support.

    The BEIP is the only randomized clinical trial of foster care as an alternative to institutional care.

    “As the only randomized clinical trial of foster care as an alternative to institutional care, the BEIP provides unique evidence for the causal effects of deprivation and subsequent caregiving enrichment on development.”

  • The paper relies on this without support.

    The current analyses are the first quantitative synthesis of individual-level BEIP data across domains.

    “Although the benefits of the foster care intervention overall have been narratively summarized (4, 10), the current analyses reflect the first quantitative synthesis of individuallevel data from the BEIP across domains.”

  • The paper relies on this without support.

    All measures of psychopathology are well validated in severely deprived children.

    “All measures of psychopathology are well validated in severely deprived children.”
5 of 5

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 moderate to strong improvements in physical growth (height, weight, BMI).

    “Moderate to strong improvements in physical growth; moderate improvements in stress responses”

    From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as King et al., 2023

    The Results section reports a significant improvement in physical growth for children assigned to foster care versus care as usual (β = 0.28). However, the Outcomes section defines physical growth as height, weight, and head circumference—not BMI—and the reported effect does not establish a strong improvement. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Institutional rearing is associated with severe psychosocial deprivation and places children at heightened risk for long-term neurodevelopmental challenges, including differences in cognitive and psychosocial functioning.

    “Institutional rearing is associated with severe psychosocial deprivation and places children at heightened risk for long-term neurodevelopmental challenges, including differences in cognitive and psychosocial functioning (King et al., 2023; Nelson et al., 2014).”

    From Foster care intervention protects cognitive control skills in young adults exposed to institutional rearing (2026) · cites this paper as King et al., 2023

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • The reported mean baseline age differs across sections

    Minor

    The methods report a mean baseline age of 20.74 months, whereas the introduction describes the enrolled children's mean age as 22 months. Rounding 20.74 to a whole month gives 21, not 22.

  • The middle-childhood psychopathology estimate falls outside its interval

    Minor

    The reported coefficient is −0.08, below the reported confidence interval's lower limit of −0.05. A confidence interval for this coefficient should contain its point estimate.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Smyke A, 1999, Disturbances of Attachment Interview
  2. Fisher PA, 2013, Child Welfare, 92, 9

Cited by

Sorted by citations

Related

Authors
King, L. S., Guyon-Harris, K. L., Valadez, E. A., Radulescu, A., Fox, N. A., Nelson, C. A., Zeanah, C. H., & Humphreys, K. L.
Affiliations
  • Tulane University (US)
  • Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans (King, Zeanah, Humphreys); Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (Guyon-Harris); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Valadez, Fox); Institute of Child Development, Bucharest, Romania (Radulescu); Boston Children’s Hospital and Harvard Medical School, Boston (Nelson); Harvard Graduate School of...
Corresponding author
Humphreys, Kathryn L.
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2023-08-01
Volume
180
Issue
8
Pages
573-583
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.20220672
PMC
PMC10751847
OpenAlex
W4377220892
Cited by
29
References
49
Citations by year
2026: 6 · 2025: 8 · 2024: 9 · 2023: 6
FWCI
7.24
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • John D. and Catherine T. MacArthur Foundation
  • Jacobs Foundation (2017‐1261‐05)
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (R21HL091363)
  • National Institute of Mental Health (R01MH091363)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (F32HD105385, P50HD103537)
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
Bucharest Early Intervention Project, foster care, institutional care, early deprivation, child development, cognitive outcomes, IQ, physical growth, EEG, psychopathology, attachment disorders, social relatedness
MeSH terms
Adolescent, Child, Child, Institutionalized, Child, Preschool, Female, Foster Home Care, Humans, Infant, Male, Psychopathology, Early Intervention, Educational, Multilevel Analysis

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 2026-09-29.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-29.

Cited sources are checked by gpt-6-sol.

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 ›

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