By Joshua Lavender
In 1966, the Romanian government began pursuing population growth policies that included bans on contraception and abortion, measures to make divorces difficult to obtain, special benefits for families with at least five children (a de facto "celibacy tax"), and even forced gynecological exams in the workplace. Romania's leader, Nicolae Ceauşescu, believed that increasing "human capital" would drive economic production, but he did not reckon with the country's poverty. When the population swelled, many Romanian families incapable of providing for their children abandoned them in state-run orphanages. And as Romania sank ever deeper into poverty and deprivation under Ceauşescu's draconian rule in the 1980s, the weakest members of society—orphans and the handicapped—became the hardest-hit victims of food and medicine shortages.
By the time of the Romanian revolution in 1989, more than 170,000 children were living in state institutions, frequently under inhumane conditions. The most notorious of these orphanages, at Cighid, was so horrific that it was common for children to die of hunger, cold, and disease during their first few weeks there. A 1990 Philadelphia Inquirer report on Cighid described children "so crippled by disease and ill treatment that they cannot walk but must slide across the floor on their hands or spend their time in soiled beds." Even after the post-revolution exposure of these conditions, attitudes were slow to change. Families continued to discard unwanted infants in state orphanages, with some in the government still insisting this was the better option for these children.
In 2000, at the invitation of Romania's National Authority for Child Protection and with help from the non-governmental organization SERA Romania, Dr. Nathan Fox and his colleagues at Harvard Medical School, Boston Childrens Hospital, and Tulane University launched the Bucharest Early Intervention Project. At once both a study of early neglect in institutional settings and a humanitarian venture to provide Romanian children with foster care, the project allowed researchers to gauge, with unprecedented precision, the effects of institutional care on neurological and emotional development in infants and young children. Dr. Fox's role was to involve magnetic resonance imaging (MRI) and electroencephalography (EEG) for studying brain activity.
Adhering to a cautious ethical framework with oversight by both Romanian and American agencies, Dr. Fox and his colleagues designed the study to follow three cohorts of children. Of a group of 136 children at six institutions in Bucharest, half were assigned to foster care overseen and financed by the research team. The other half stayed in institutions as a control group, though the researchers practiced a strict policy of noninterference regarding the government's decisions about their placement in care. The third group consisted of never-institutionalized Romanian children, whose results the researchers could compare with the development of children in the other groups. Both longitudinal and comprehensive, the research assesses childrens environments, cognitive and brain function, social-emotional development, attachment to caregivers, language development, physical growth, behavior, and psychiatric symptoms.
The results show that movement out of institutional care and into foster care makes dramatic differences in children’s development. The researchers have clarified the importance of “sensitive periods” in which neural stimulation and the intimacy of caregiving impact intelligence and emotional attachments. Institutionalization’s effects can be long-lasting: some children in foster care still face lower IQs, social-emotional problems, and deficits in language use and executive function. But the findings have also been hopeful, showing that children made developmental gains in almost every area after placement in foster care. Dr. Fox's MRI and EEG analyses have revealed the potential to recover developmentally from the deprivations of institutionalization.
Attesting forcefully to the importance of placing children with nurturing families as early as possible, this research implies some sharp criticism for existing policies that impact children's health and development. A common societal answer to the needs of orphaned and abandoned children is to place them in institutions. Over a decade ago, at least eight million children were estimated to be institutionalized worldwide. In an April 2013 Scientific American article taking stock of their project's findings, Dr. Fox and his colleagues questioned the worth of this ubiquitous response.
"[Our] findings clearly demonstrate the devastating impact on mind and brain of spending the first two years of life within the impersonal confines of an institution," the researchers write in Scientific American. "The Romanian children living in institutions provide the best evidence to date that the initial two years of life constitute a sensitive period in which a child must receive intimate emotional and physical contact or else find personal development stymied. . . . Foster care did not completely remedy the profound developmental abnormalities linked to institutional rearing, but it did mostly shift a child's development toward a healthier trajectory."
Influenced by this research, Romania has outlawed the institutionalization of children younger than two years old and increased its efforts to place children in foster care. Fourteen years after the Bucharest Early Intervention Project began, most of the children from the original study have been placed with families.
Dr. Nathan Fox is the chair of the Department of Human Development and Quantitative Methodology, a Distinguished University Professor, and director of the Child Development Lab. His research explores human developmental neuroscience; infant and child temperament; and the development of social cognition, emotion, and emotion regulation. In 2014, Dr. Fox was elected to the American Academy of Arts and Sciences.
The Bucharest Early Intervention Project has received support from the Robert Wood Johnson Health and Society Scholars Program, the Harvard School of Public Health, the John D. and Catherine T. MacArthur Foundation, the Binder Family Foundation, the Help the Children of Romania Foundation, and the National Institute of Mental Health.
