• By Dartington SRU
  • Posted on Tuesday 19th July, 2011

Fostering improvement

The project involves an intervention where a group of children living in six institutions (orphanages) in Bucharest, Romania were placed into foster care homes. Foster parents received parent training. Prior to placement, they visited their children in the institution so they could start developing a relationship with the child. Foster parents also received support from social workers. The latter received weekly consultation from US staff who were experienced in dealing with young children in foster care.To compare foster care and other forms of care, 136 children, aged five to 31 months, originally took part in the Bucharest Early Intervention Project. Of these, 68 were allocated to foster care for the purposes of a randomised controlled trial, while the same number received other forms of care, including that in institutions. An additional group of 72 children were recruited from pediatric clinics in communities to act as a control group.The effects of foster care intervention, the timing of placement and children’s cognitive development were previously observed when children were 30, 42, and 54 months old. The initial findings indicated that children who were placed in foster care showed higher IQ scores compared to those who remained in remained in the six orphanages in Bucharest. Those who were removed before they were 24 months old did best. The current study re-assessed 103 of these children 3 ½ years after the intervention was completed and they were eight years old. The authors examined the IQ scores of children who received other forms of care and children who were placed into foster homes. Comparisons were also made between children in foster and the 38 children, who had lived in the community and had never experienced care. In order to examine whether there is a continuing effect of early intervention on IQ at the age of eight, the authors conducted intent-to-treat analysis by comparing fostered children to those receiving other forms of care on the subscales of Wechsler Intelligence Scale for Children and on the full scale of IQ scores. The results indicated that fostered children scored higher on the verbal subscale than those in other forms of care. There was no significant group difference on full-scale IQ sores. The authors also explored the how fostered children fared against typically developing community children. The results revealed that the latter group scored significantly higher verbal, perceptual, working memory and processing speed subscales of WISC. They also had significantly higher full-scale IQ scores compared to children in foster care. Thus, the latter had not “caught up” to their non-institutionalized peers in terms of IQ. When it comes to change in IQ scores between assessments at age 54 months and eight years, children in foster care showed little change in full-scale IQ scores, while children in other forms of care showed modest increases. In addition, children with lower scores at baseline showed greater improvements in IQ over that time period. The results also revealed that children fostered before they were 26 months old had significantly higher scores in the time taken to perform tasks, than children placed after that age. Because of the large number of changes in placement over eight years, the authors examined the effects of current placement on IQ. The results indicated that children living in foster care covered by the BEI scored significantly higher on the verbal subscale of the WISC than children living in institutions. They also scored higher than children living in foster care on the WISC working memory and processing speed subscales. Similar findings applied to full-scale IQ scores. Children initially assigned to the intervention who were currently living in BEIP foster care were also compared to those who were now living either in government foster care or were reunited with their biological families. The results revealed that children who were still living in BEIP foster care scored significantly higher on three WISC subscales compared to those who were no longer covered by intervention. Changes in placement for children in foster care were not affected by age at placement or attachment security. The authors also examined change scores within each group of children in care and then examined the longitudinal pathways of IQ of these groups from 30 months to 8 years of age. They found that there was a significant increase in IQ for the children in other forms of care but not for those who were fostered. They also found two trajectories for each group: one describing more typical IQ scores and the second describing lower scores over time. Security of attachment at 42 months and language abilities were significant predictors of IQ profiles in the children who experienced other forms of care. For fostered children, both of these predictors as well as positivity in the caregiving relationship were significantly predictive of IQ profiles. These results emphasize the importance of the quality of the environment in sustaining IQ scores of previously institutionalized children. The results provide evidence for the longer-term effects of foster care, with positive impact on children’s IQ demonstrated from 30 months to eight years of age. However, the results for IQ at age eight were not as strong as previously reported at 42 and 54 months. Nevertheless, the IQ scores of children in foster care remained remarkably stable from 54 months to eight years of age. Also, changes in IQ over time were most obvious for children who remained in an institution – their mean IQ score increased over time. According to the authors, these findings imply that the initial intervention effects for children in foster care have not disappeared. The authors suggest that the lack of significant group differences is likely due to the modest improvements in IQ of children growing up in institution.Children who were placed into foster care before 26 months of age were more likely to be in the typical profile compared to those fostered children in the low profile. Thus, the timing of intervention has an important effect on early experience in supporting positive cognitive development. Furthermore, IQ either remained low but stable over time or showed some increase in those children who experienced other forms of care. This suggests that IQ does not necessarily continue to decrease over time in institutional care as suggested in earlier studies using cross-sectional studies. However, the authors acknowledge that the relatively small sample size may have limited their ability to find more than two profiles of IQ, so that their data may represent patterns that exist within the sample examined and not necessarily in the general population. Also, the sample size may be responsible for the modest effect sizes reported in the paper. Reference:Fox, N. A., Almas, A. N., Degnan, K. A., Nelson, C. A., Zeanah, C. H. (2011). The effects of severe psychosocial deprivation and foster care intervention on cognitive development at 8 years of age: findings from the Bucharest Early Intervention Project. Journal of Child Psychology and Psychiatry.

Back to Archives