Foster care improves child development compared with institutional care

Key takeaways:

• Young children placed in foster care had better cognition and physical outcomes through adolescence compared with children in institutional care.
• They also had less severe psychopathology.

SAN FRANCISCO — Compared with children placed in institutional care, those placed in foster care at a young age had better cognitive, physical and psychopathological outcomes through adolescence, according to findings presented here.

The study, which was published in The American Journal of Psychiatry, is the only randomized-controlled trial evaluating outcomes of foster care and institutional care for young children to date, study author Kathryn L. Humphreys, PhD, EdM, an assistant professor in the department of psychology and human development at Vanderbilt University in Nashville, said during a presentation at the American Psychiatric Association annual meeting.

Beginning in 2000, Humphreys and colleagues enrolled 136 children aged 6 to 31 months from six institutions in Bucharest, Romania, in the Bucharest Early Intervention Project (BEIP). The researchers randomly assigned children 1:1 to high-quality foster care or care as usual. The foster care intervention provided support for foster parents so they could provide for the child’s physical and psychological needs. Of note, care as usual did not exclude children from ever being placed in foster care, but they may have waited longer to be placed in foster care compared with their counterparts.

Primary outcomes were cognitive function, physical growth and psychopathology at ages 30 months, 42 months, 54 months, 8 years, 12 years and 16 to 18 years.

In the final round of follow-up, there were 53 children in the foster care group and 56 children in the care as usual group.

Overall, children placed in foster care had better combined cognitive, physical and neural outcomes compared with children who received care as usual, as well as greater IQ and physical growth.

Children in the foster care intervention group also had less severe psychopathology overall compared with their counterparts. Specifically, they had significantly less severe disinhibited social engagement disorder, reactive attachment disorder and internalizing symptoms. There were no significant differences in ADHD symptoms or externalizing symptoms between groups.

Within the foster care intervention group, earlier placement in foster care was associated with greater cognitive, physical and neural outcomes. Additionally, the stability of foster care — whether or not children stayed with their original foster families — was linked to differences in outcomes. Specifically, the effect of foster care stability was greatest during adolescence, with children who had stable placements having better cognitive, physical and psychopathological outcomes compared with children whose placements were disrupted.

“The Bucharest Early Intervention Project tells us about a number of things that may be helpful for long-term care for children who are orphaned or abandoned across the world,” Humphreys said during the presentation. “There are millions of orphans living in institutions today, and we have insight from the BEIP that early placement in families and making sure those families are child-centered, that they make a psychological commitment to the children and that are to be there and provide them care throughout their lives is really important.”

References:

• Humphreys KL, et al. A comprehensive multi-level analysis of the Bucharest Early Intervention Project: Causal effects on recovery from early severe deprivation. Presented at: American Psychiatric Association Annual Meeting; May 20-24, 2023; San Francisco.
• King LS, et al. Am J Psychiatry. 2023;doi:10.1176/appi.ajp.20220672.