Romanian children who were placed in orphanages at birth improved their cognitive development significantly if they were moved to foster homes, particularly before turning 2 years old, a Harvard study has found.
Children who live in institutions from a very early age suffer delays in development, from low IQs that would be called mental retardation by US standards, to lags in language and problems with behavior, according to previous research. This new study in Science, by lead author Charles A. Nelson III of Harvard Medical School and Children's Hospital Boston, is the first randomized clinical trial to compare the intellectual and developmental levels of children who remained in orphanages with children who moved to foster homes. Children from the Bucharest area who had never been in institutions were a control group. A story in the Globe last year described the ongoing study.
Earlier observational studies have looked at how well children who leave orphanages fare compared with children who stayed behind, but that approach might not account for whether children chosen for adoption or foster homes are healthier than those who remained in the institutions, the authors wrote.
There were no foster homes in Romania before the study began, so Nelson and his colleagues at the Bucharest Early Intervention Project had to create a new system. From 136 children living in six Bucharest orphanages whose average age was 22 months, they randomly chose 68 children to stay in institutional care and 68 to go into foster families. There were 72 children in the never-institutionalized control group. All children had their development and intellectual abilities measured at the time of enrollment and then again when they were two-and-a-half, three-and-a-half, and four-and-a-half years old.
The children who moved into foster homes had intelligence and development scores about 8 points higher on average than the children who remained in orphanages, but they were still about 18 points below children who have never been in institutions. Children placed in foster care earlier had scores about 10 points below never-institutionalized children.
“The good news is how much we boosted IQ generally,” Nelson said in an interview. “The younger a child is when placed in foster care, the better the outcome.”
But even the children moved to foster care at early ages didn’t catch up to the children who had never been institutionalized.
“We expected that if kids were placed young enough they would have IQs that would return them to normal,” Nelson said. “In fact they didn’t. At least not yet.”
Dr. Laurie C. Miller, director of the International Adoption Clinic at The Floating Hospital for Children, called the study "very compelling."
"This study is the first to demonstrate the exact 'costs' to the child of early institutionalization -- a month by month loss in cognitive development (or IQ)," she said in an e-mail interview. "Although Romanian orphanages may differ from those in other countries, the urgent findings in this very compelling study should serve as a guideline for governments throughout the world attempting to address the problems of children without parents."
The researchers are testing the children again at ages 7 and 8 to see if the benefits of foster care may take longer to appear in some children.
They’d also like to know if there is a sensitive period under 2 years old for placing children in foster homes, Nelson said. But now that they know foster care helps children, it would not be ethical to test whether moving a child at 3, 6 or 9 months old is critical.
A policy forum article also appearing in Science says that the Nelson study was ethical because the authors did not know before the study was done how helpful their intervention would be, particularly since there was no existing foster care system.
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|White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at firstname.lastname@example.org. Follow her on Twitter: @cconaboy.|
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