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Cognitive Legacy of Early Institutionalization: A Closer Look

Do cognitive abilities differ between children raised in institutions and those raised in foster care?

Social policy in Romania traditionally included placing abandoned children in institutions, not in foster care. In this study conducted in Romania, researchers investigated differences in cognitive abilities among children raised in institutions, in foster care, or in the homes of their biological families. The investigators randomized 136 children institutionalized at or shortly after birth to remain in institutions or to be raised in foster families recruited by the investigators. Controls were 72 typically developing, sex- and age-matched children raised within their families. Age-appropriate standard cognitive testing was performed at baseline and at 30, 42, and 54 months. Although the status of some children changed during the study, analyses were based on initial placement.

Compared with the control group, both the foster-care and the institutionalized groups had substantially lower mean cognitive scores at 42 months (103.4 vs. 85.7 and 77.1, respectively) and at 54 months (109.3 vs. 81.0 and 73.3, respectively). The foster-care group had significantly higher scores than the institutionalized group at both assessments. At 42 months, but not at 54 months, younger age (24 months) at foster-care placement was associated with significantly stronger improvement in scores. Controls’ scores were similar to those in other comparable populations.

Comment: This unique and remarkable study demonstrates that typical families were substantially better than institutionalization for children’s intellectual development. Regrettably, even foster care left abandoned children considerably behind controls developmentally. A question that warrants future study is whether enhanced foster care might close this serious gap. Based at least partially on this study, Romania no longer allows institutional care of abandoned children, unless they are seriously disabled.

— Barbara Geller, MD

Published in Journal Watch Psychiatry February 11, 2008

Citation(s):

Nelson CA III et al. Cognitive recovery in socially deprived young children: The Bucharest Early Intervention Project. Science 2007 Dec 21; 318:1937.

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