The Effects of Psychosocial Deprivation on Attachment: Lessons from the Bucharest Early Intervention Project
Open accessAbstract
The absence of typical caregiving, including warm and responsive parenting, has been suggested to significantly affect the young child's ability to form adaptive relationships with adults and peers. The Bucharest Early Intervention Project (BEIP), a randomized controlled trial of foster/family care for young children with a history of institutionalization has provided the context to assess these relationships. Here we review data from the BEIP with specific focus on attachment. The findings clearly show the importance of early family care on the emergence of attachment, on the prevention of psychopathology, and on links between brain and social behavior.
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Developmental functioning across neurobiological, cognitive, socioemotional, and physical domains interacts dynamically over time, such that adaptive functioning in one domain may promote more favorable outcomes in another.
“developmental functioning across neurobiological, cognitive, socioemotional, and physical domains interacts dynamically over time, such that adaptive functioning in one domain may promote more favorable outcomes in another.”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Fox et al., 2017
The paper’s Abstract reports that attachment security predicted later cognitive and socioemotional outcomes, and that brain activity moderated the association between attachment and social skills in previously institutionalized children. This supports the idea that functioning in one domain may relate to outcomes in another, but the paper does not establish dynamic interaction across all four named domains, particularly physical functioning. (LLM, conf=0.86)
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Cites
Attachment in institutionalized and community children in Romania.
Zeanah, C. H., Smyke, A. T., Koga, S. F., Carlson, E., & The Bucharest Early Intervention Project Core Group (2005) · Child Development · doi:10.1111/j.1467-8624.2005.00894.x · Cited by 516 · cited 1× · see citing works
“At baseline, we found that children living in institutions were significantly more likely to exhibit signs of both reactive attachment disorders and disinhibited social engagement disorder (Zeanah et al., 2005).”
BackgroundSelf-citationZEANAH, C. H., NELSON, C. A., FOX, N. A., SMYKE, A. T., MARSHALL, P., PARKER, S. W., & KOGA, S. (2003) · Development and Psychopathology · doi:10.1017/s0954579403000452 · Cited by 447 · see citing works
Self-citationVariation in neural development as a result of exposure to institutionalization early in childhood
Sheridan, M. A., Fox, N. A., Zeanah, C. H., McLaughlin, K. A., & Nelson, C. A. (2012) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1200041109 · Cited by 432 · see citing works
Self-citationVanderwert, R. E., Marshall, P. J., Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2010) · PLoS ONE · doi:10.1371/journal.pone.0011415 · Cited by 203 · see citing works
Self-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-citationRecovering from early deprivation: attachment mediates effects of caregiving on psychopathology
McGoron, L., Gleason, M. M., Smyke, A. T., Drury, S. S., Nelson, C. A., Gregas, M. C., Fox, N. A., & Zeanah, C. H. (2012) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2012.05.004 · Cited by 133 · see citing works
Self-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
“signs in girls at 54 months, sustained levels of stable, typical IQ scores through age 12 years (Almas et al., 2016), social skills at 8 years (Almas et al.”
BackgroundSelf-citationHumphreys, K. L., McGoron, L., Sheridan, M. A., McLaughlin, K. A., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2015) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2015.09.010 · Cited by 41 · see citing works
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Research works printed but not linked: 15
- Almas AN Degnan KA Radulescu A Nelson CA Zeanah CH Fox NA 2012 Effects of early intervention and the moderating effects of brain activity on institutionalized children’s social skills at age 8 Proceedings of the National Academy of Sciences 109 Suppl. 2 17228 17231 https://doi.org/10.1073/pnas.1121256109 PMC3477393 23045660 · DOI · Paper page
- Bowlby J 1952 Maternal care and mental health Geneva World Health Organization PMC2554008 14821768
- Carlson EA Hostinar CE Gunnar MR 2014 The emergence of attachment following early social deprivation Development and Psychopathology 26 469 489 PMC4404709 24621881
- Dobrova-Krol NA Bakermans-Kranenburg MJ van IJzendoorn MH Juffer F 2010 The importance of quality of care: Effects of perinatal HIV infection and early institutional rearing on preschoolers’ attachment and indiscriminate friendliness Journal of Child Psychology and Psychiatry 51 1368 1376 20456538
- Gleason MM Fox NA Drury SS Smyke AT Nelson CA Zeanah CH 2014 Indiscriminate behaviors in young children with a history of institutional care Pediatrics 133 3 e657 e655 https://doi.org/10.1542/peds.2013-0212 24488743 PMC3934326 · DOI
- Herreros F Neriz C Magnani ML 2014 An investigation of the attachment formation and organization of infants living in Chilean institutions Presented at the Inter-American Attachment Conference Attachment Theory: A Humanistic Approach for Cross-Cultural Research and Practice University of San Diego San Diego, CA
- Humphreys KL Gleason MM Drury SS Miron DM Nelson CA Fox NA Zeanah CH 2015 Effects of early deprivation on psychopathology at age 12 years: Follow-up of a randomized controlled trial The Lancet Psychiatry 2 625 634 26303560 PMC4550037
- Humphreys KL Miron D McLaughlin KA Sheridan MA Nelson CA Fox NA Zeanah CH (under review) Foster care promotes adaptive functioning in early adolescence among children who experienced severe, early deprivation PMC6214343 29389015
- Marshall PJ Fox NA BEIP Core Group 2004 A comparison of the electroencephalogram between institutionalized and community children in Romania Journal of Cognitive Neuroscience 168 1327 1338 15532128
- McLaughlin KA Zeanah CH Fox NA Nelson CA 2012 Attachment security as a mechanism linking foster care placement to improved mental health outcomes in previously institutionalized children Journal of Child Psychology and Psychiatry 53 1 46 55 https://doi.org/10.1111/j.1469-7610.2011.02437.x 21733136 PMC3193871 · DOI · Paper page
- Nelson CA Fox NA Zeanah CH 2014 Romania’s abandoned children: Deprivation, brain development and the struggle for recovery Cambridge, MA Harvard University Press
- Rutter M Sonuga-Barke EJ Castle J 2010 Investigating the impact of early institutional deprivation on development: Background and research strategy of the English and Romanian Adoptees (ERA) study Monographs of the Society for Research in Child Development 75 1 1 20 20500631
- Smyke AT Zeanah CH Fox NA Nelson CA Guthrie D 2010 Placement in foster care enhances quality of attachment among young institutionalized children Child Development 81 212 223 20331663 PMC4098033
- Vanderwert RE Zeanah CH Fox NA Nelson CA 2016 Normalization of EEG activity among previously institutionalized children placed into foster care: A 12-year follow-up of the Bucharest Early Intervention Project Developmental Cognitive Neuroscience 17 68 75 26724564 PMC4727988
- Zeanah CH Gleason MM 2015 Attachment disorders in early childhood—Clinical presentation, causes, correlates and treatment Journal of Child Psychology and Psychiatry 56 3 207 222 25359236 PMC4342270
Cited by
Sorted by citations
Holt-Gosselin, B., Adri, F., Humphreys, K. L., & Nelson, C. A. (2026) · Development and Psychopathology · doi:10.1017/s0954579426101837
“Indeed, BEIP studies have demonstrated cross-domain developmental associations (Fox et al., 2017; McGoron et al., 2012; Wade et al., 2020a).”
Self-citation
- Authors
- Fox, N. A., Nelson, C. A., & Zeanah, C. H.
- Affiliations
- Professor, Department of Human Development and Quantitative Methodology, University of Maryland.
- Harvard University (US)
- Tulane University (US)
- Venue
- Psychodynamic Psychiatry
- Publisher
- Guilford Publications
- Published
- 2017-12
- Volume
- 45
- Issue
- 4
- Pages
- 441-450
- ISSN
- 2162-2590 (ISSN-L)
- PMC
- PMC5813245
- OpenAlex
- W2773591044
- Cited by
- 29
- References
- 8
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 5 · 2019: 7 · 2018: 1 · 2017: 1
- FWCI
- 8.79
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychodynamic Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH091363)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U54HD090255)
- Topics
- Social Sciences › Safety Research › Child Welfare and Adoption
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- psychosocial deprivation, attachment, Bucharest Early Intervention Project, institutionalized children, foster care, family care, early intervention, parenting, interpersonal relationships
- MeSH terms
- Child, Child Abuse, Child, Preschool, Female, Foster Home Care, Humans, Infant, Institutionalization, Male, Object Attachment, Psychosocial Deprivation, Romania, Randomized Controlled Trials as Topic
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