For the past 12 years we have conducted the first-ever randomized controlled trial (RCT) of foster care as an intervention for young abandoned children placed in institutions. Beginning with a sample of 136 Romanian infants abandoned to institutions early in life, we compared two groups. Half of this sample was randomly assigned to be removed from the institution and placed into a family/foster care intervention. The other half remained in the institutions receiving care as usual. We did not interfere with any placements deemed in the children?s best interest by child protection authorities in Bucharest. Over time, some children from both groups were adopted within Romania or reintegrated with their biological parents. Throughout we followed intent-to-treat analyses so that original group assignment defined group membership despite the fact that few of the ?care as usual? children remained in the institutions over the long run. A comparison sample of 72 never institutionalized children provided normative data. The original sample of institutionalized children has been followed through 12 years of age. We assessed the children's cognitive, social, psychiatric and brain outcomes at multiple assessment points across these 12 years. To date, the results indicate that a) early institutionalization leads to perturbations in the brain?s electrical (EEG) and structural (MRI) development, with profound deficits and delays in cognitive and socio-emotional behaviors, and an elevated incidence of psychiatric disorders and impairment, b) our intervention was broadly effective in enhancing children?s development, but c) for specific domains of neural activity, language, cognition and social-emotional functioning there appear to be sensitive periods mediating recovery. In the current proposal, we assess the children when they are 16 years of age and extend these analyses with the aim to predict mental health outcomes in two groups of children: those originally assigned to our Foster Care intervention [FCG] and those originally randomized to remain in the institution (Care as Usual Group [CAUG]) and we will compare their functioning to typically developing age-matched Romanian children (Never Institutionalized Group [NIG]). Using a variety of both brain and behavioral measures, we will 1) examine, at age 16, the long term impact of early institutionalization on mental health outcomes and the efficacy of our intervention in ameliorating the burden of mental health outcomes using an intent-to-treat design;2) examine how the dose of institutionalization (percent time spent in an institution) influences long term outcomes;3) examine sensitive periods in recovery from early institutionalization;and 4) focus particularly on risk taking behavior, substance use, and mental health outcomes.

Public Health Relevance

There are currently more than 70 million orphaned or abandoned children throughout the world. A common societal response to caring for such children is to house them in institutions. Children with histories of early institutionalization ar at risk for developing a variety of mental health problems that have their origin in abnormal social behavior. The current application will examine the long term effects of early institutionalization on mental health outcomes in two groups of children with a history of institutionalization, as well as explore sensitive periods in recovery from institutionalization.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Child Psychopathology and Developmental Disabilities Study Section (CPDD)
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Zehr, Julia L
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Children's Hospital Boston
United States
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Guyon-Harris, Katherine L; Humphreys, Kathryn L; Degnan, Kathryn et al. (2018) A prospective longitudinal study of reactive attachment disorder following early institutional care: considering variable- and person-centered approaches. Attach Hum Dev :1-16
Johnson, Dana E; Tang, Alva; Almas, Alisa N et al. (2018) Caregiving Disruptions Affect Growth and Pubertal Development in Early Adolescence in Institutionalized and Fostered Romanian Children: A Randomized Clinical Trial. J Pediatr 203:345-353.e3
Guyon-Harris, Katherine L; Humphreys, Kathryn L; Fox, Nathan A et al. (2018) Signs of attachment disorders and social functioning among early adolescents with a history of institutional care. Child Abuse Negl 88:96-106
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Lamm, Connie; Troller-Renfree, Sonya V; Zeanah, Charles H et al. (2018) Impact of early institutionalization on attention mechanisms underlying the inhibition of a planned action. Neuropsychologia 117:339-346
Tang, Alva; Slopen, Natalie; Nelson, Charles A et al. (2018) Catch-up growth, metabolic, and cardiovascular risk in post-institutionalized Romanian adolescents. Pediatr Res :
Humphreys, Kathryn L; Miron, Devi; McLaughlin, Katie A et al. (2018) Foster care promotes adaptive functioning in early adolescence among children who experienced severe, early deprivation. J Child Psychol Psychiatry 59:811-821
Bick, Johanna; Zeanah, Charles H; Fox, Nathan A et al. (2018) Memory and Executive Functioning in 12-Year-Old Children With a History of Institutional Rearing. Child Dev 89:495-508

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