• By Kevin Mount
  • Posted on Tuesday 12th February, 2008

Trials damn Romanian institutional care

Many countries struggle to know how best to look after children abandoned by their families, and the pendulum of political opinion still swings across the range of possibilities. Perhaps most of us would not question an instinct that children – particularly the very young – fare better in a family context than in an institution, and some may still turn for hard evidence to comparative studies of monkeys conducted in the 1960s. Those reared in isolation emerged severely disturbed; others raised in the presence of even a terry-cloth “mother” fared much better. [See "Total social isolation in monkeys"].The research on humans is not so clear. Most studies that have compared children reared in institutions to those cared for by adoptive or foster families suffer from what researchers call “selection bias”. Children made available for adoption or foster care are sometimes the healthiest, best adjusted kids. In other words, from the outset they differ from their counterparts who remain institutionalized. So it’s not clear whether differences between the two groups observed later in life are the result of their initial differences or the type of care they received when they were growing up.The best way to clarify which type of care is better is to take a group of abandoned children and randomly choose some of them to experience foster care and others to experience institutionalization. But is this ethical? Yes, say the authors of a recent study that did just that. Charles A. Nelson at Harvard Medical School and colleagues at four other US universities readily concede that it is unethical to give an individual a treatment that is known to be inferior. But they would argue that prior to their study there was no clear evidence that foster care was superior to institutional care for young children. Working with the Romanian government, the researchers compared the progress of abandoned children reared in Romanian institutions to that of other abandoned children originally placed in institutions but transferred to foster care. Young children living in institutions were randomly allocated to one or other group. The team found that the intellectual functioning of the children who remained in the institutions was markedly below that of children placed in foster care. Indeed, the researchers describe the average IQ of children in institutions as “borderline mental retardation”. Additionally, the younger the children when they were placed in foster care, the better they fared. Nelson and his colleagues claim that their research shows the advantages of family placements for young abandoned children (although their study did not take into consideration the quality of institutional care). And the Romanian government listened. Several years after the study began, the government passed a law prohibiting the institutionalization of children younger than two, unless severely handicapped.Summary of “Cognitive Recovery in Socially Deprived Young Children: The Bucharest early intervention project” by Charles A. Nelson, III, Charles H. Zeanah, Nathan A. Fox, Peter J. Marshall, Anna T. Smyke, and Donald Guthrie in Science, 21 December 2007, Volume 318, Number 5858, pp1937 – 1940.See also: coverage by the Developmental Medicine Center at the Children's Hospital, Boston

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