… a controlled study comparing a group left in orphanages with a group randomly selected for high-quality foster care in Romania. In a stream of reports since 2003, they have shown that children reared in institutions suffer an array of setbacks, some reflecting long-term changes in the brain (Science, 21 December 2007, p. 1937). The team is now analyzing data from the 12th year, measuring things like disparities in brain structure.
Findings from the Bucharest project have buttressed those from smaller and less controlled studies, many based on U.S. children in troubled homes. “We are all reporting the same effects,” says Megan Gunnar, a clinical psychologist at the University of Minnesota (UMN), Twin Cities, who is not part of BEIP. “The brain needs stimulation to develop,” and when it doesn’t get it, cognitive and emotional growth are stunted.
Today, Nelson is convinced that early life without parenting can be “more disastrous for brain development” than living with an abusive caregiver. But the Romanian work also confirms that many children can bounce back to something like normality, if placed in a supportive environment. …
… The “creepiest thing” about the Romanian orphanages and other places where young children suffer chronic neglect is that “they’re quiet,” Pollak says. In most U.S. elementary schools or child care centers, he says, “you hear talking and screaming and crying … it’s just raucous.” But in “an environment where children are not being attended to, there is this kind of dead silence. … Children are learning: ‘Why should I cry, or gesture, or make eye contact if no one is responding?’” …
… After screening to exclude children with genetic or neurological abnormalities, study leaders selected 136 children for the trial, ranging in age from 6 to 31 months. By random assignment, 68 went into a group that received BEIP-funded foster care and 68 were left to continue with “usual” care—that is, they lived in an institution. Foster caregivers were screened, trained, and paid a “living wage,” Nelson says. It was deluxe care even by U.S. standards. BEIP experts monitored and consulted with the caregivers, who also had 24-hour pediatric medical backup. As controls, BEIP included a group of 72 children from Romanian communities who had never lived in an institution. Researchers gathered test results at 30 months, 42 months, 54 months, 8 years, and 12 years. They have been funded to return at 15 years.
Children in the institutional care group showed dramatic deficits on a variety of measures when compared with the community group. In an age-adjusted system that converts test results from young children into IQ-comparable scores, known as the developmental quotient (DQ) scale, the institutionalized kids at the outset earned an average DQ score of 74 compared with 103 for the community group. This was “two standard deviations below the mean” for children of that age, according to BEIP, suggesting “profound intellectual delay.”
In time, the kids placed into foster care advanced toward the normal DQ and IQ ranges, though they continued to lag behind the community group. When BEIP tested children at 42 months, researchers found that the older a child was when placed into foster care, the lower the cognitive score was likely to be. Those who left the institution by 18 months scored above 90 on the DQ scale, whereas those who left at 24 to 30 months scored just over 80. Those who remained in institutions up to age 8 exhibited a “progressive decrease in IQ with age,” the BEIP authors wrote.
Strangely, as they reached 8 years of age, the foster care children began to slow their climb into higher DQ and IQ scores and came to rest on a par with the children in the institutionalized group, with IQ scores hovering near 80. Both ranked “far below” children who had never lived in an institution, according to BEIP, perhaps because their recovery from the effects of early neglect had reached a ceiling. …
… The good news is that IQ does seem to rebound in children who leave institutional care—the sooner they leave, the better, according to Nelson’s group. BEIP found that children who left an institution by 24 months seemed to recover best. Other researchers agree about the need to get out early, but differ about timing. For example, the United Kingdom’s ERA study found that children adopted into British families seemed to score just as well as community kids if they left the institution by 6 months of age. Both BEIP and ERA have found that certain behavioral problems, such as poor attention and hyperactivity, persist among kids who were in institutions for any period. …
… members of the BEIP group reported on an imaging study of Romanian children 8 to 11 years old. Using magnetic resonance imaging, Margaret Sheridan of Boston Children’s Hospital and others found that Romanian kids raised in an institution had significantly less brain tissue, especially gray matter (a mix of various cell bodies), than those who had never lived in an institution. But children who had been placed in foster care showed a smaller deficit. “These reflect profound effects on the brain,” Nelson says.
Like other studies, the BEIP project suggests that brain development passes through critical periods. The first 24 months of life seem especially important for cognitive development, and Nelson says that the critical period for healthy attachment to a parent lasts through the first 20 to 22 months. For language, the window appears to be up to 16 months. But** there are no sharp lines**, says UMN’s Gunnar. “The general story seems to be that the brain is remarkably plastic” and can find many ways around obstacles. But neglect makes things harder. …
