On the last day of the DI conference in Sofia, last month, we were treated to an amazing presentation by the three researchers who set up and are running the Bucharest Early Intervention Project. This is a longitudinal study done in Romania to compare the outcomes for 136 children who were placed in an institution and of whom half stayed in the institution – as they would have if the research project had not taken place – and half were placed in high quality foster care, set up by the research team. And in addition 72 children who grew up in their own families, having never been placed in care, were followed as a comparison group.
Dr Charles A Nelson gave the first presentation, starting by giving an overview of how the plasticity of the brain decreases with age. He mentioned that profound psychosocial deprivation equals extreme neglect in the impact on children. Amazingly, he was able to show that in 1909 and 1915 there were already mentions of the need to get children out of institutions and into family-based care.
Then he gave an overview of the set-up of the research project, which was started in 2000 and is still running. The children were divided up into three groups, as described above. And then they were visited for tests at age 18 months, 30 months, 54 months, 7 years, 12 years and 16 years. The data for age 16 was collected last year, and the researchers will go back one more time at 21 years. During each round of tests and observations, they recorded results for physical development, psychosocial development, stress response, neurological development and mental health state.
Professor Nathan Fox then presented some results on the neurological development of the children. These showed marked differences between the groups, with the development of children who are institutionalised much more abnormal than that of children in foster families. However, what was particularly striking, was that there was a very significant difference in outcome between children who had been taken out of the institution and placed in a family before they were 24 months old and those who were placed in a family after they were 24 months old. The results of the former group were much closer to those of children who had never been in an institution and the results of the later group quite close to those of children who were institutionalised.
As Professor Fox put it, the brain is constructed to expect certain kinds of stimulation for development, both sensory stimulation and social stimulation. And in the next presentation Dr Charles Zeanah reinforced that by saying that the neuron (in the brain) doesn’t know where the child is (in a family or in an institution), it just knows whether it’s getting what it needs.
Dr Zeanah gave a presentation on the mental health results of the research project to date. These showed a similar division to that of Professor Fox. There were significantly more mental health problems among the institutionalised children than there were among the children in foster care, and least in children who had never been in institutions. With better results for children who had been placed in foster care before 24 months.
He mentioned that it looks like secure attachments protect against psychiatric problems, and that stability of placement matters. Because a further break down of the results also shows that children in foster care with one or more placement disruptions (so who have been moved to different foster families) have more mental health problems than those without placement disruptions. The possibility for the problems causing placement disruptions being at the heart of the mental health problems, was adjusted for.
It was really amazing to get to see a presentation of such an important and unique research project by the people who came up with it and made it happen. And to have the opportunity to speak with Dr Fox and Dr Nelson afterwards.
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