How Durable Are Foster Care’s Benefits?

A $3.4 million grant award from the National Institutes of Health will support University of Maryland College of Education research assessing how foster care in early childhood influences previously institutionalized children as adults.

The study, led by Distinguished University Professor Nathan A. Fox, extends his long-term project following previously institutionalized children in Romania to compare outcomes between foster care and state-run institutions. It will evaluate whether the benefits of foster care—which alleviates some of the negative effects of early childhood adversity on cognitive, emotional and neurobiological processes—have continued into their adulthood.

“This project is important in terms of understanding the effects of adversity on long-term mental health and brain outcomes,” said Fox, of the Department of Human Development and Quantitative Methodology.

The award from the National Institute of Mental Health will provide five years of funding to support Fox’s ongoing research in Romania, which from the mid-1960s until 1990 under the rule of Nicolai Ceascescu had harsh policies outlawing abortion and contraception, and penalizing families for not having a large number of children. The policies resulted in significant child abandonment and extremely poor conditions in state-run institutions.

Fox first became involved in Romania around 1999, when the country banned international adoption. With the backing of the Romanian government, he started the Bucharest Early Intervention Project, which followed institutionalized children who were or were not placed—through a randomized control trial—in high-quality foster care. The Bucharest Early Intervention Project’s other co-leaders are Harvard Medical School’s Charles A. Nelson III, and Dr. Charles H. Zeanah Jr., of Tulane University School of Medicine.

The children ranged in age from 6-31 months when they entered foster care, and initial follow-up assessments were completed at 30, 42 and 54 months, with subsequent checkups at 8 ,12 and 16 years old. Among the project’s important findings so far: Foster care is critical in remediating many, but not all, of the detrimental effects of institutionalization. Additionally, the earlier foster care is received, the better the health and developmental outcomes for formerly institutionalized children.

“The timing matters,” Fox said. “So that the earlier the child is taken out, particularly before the age of 2 the more likely that remediation is to take place.” The NIH grant will facilitate study of the children at age 21 to determine if the positive influence of foster care has held up in adulthood. The project, ongoing for 20 years, originally included 136 children, and Fox has maintained contact with 120 of them, most of whom still reside in Romania.

“What we want to know is whether or not the effects of our early intervention persist as these kids leave the institutions and go off to start families of their own,” Fox said. “So now that these 21-year-olds are adults, how’re they adapting to life outside the institution?”

Fox will use behavioral data amassed over the course of the project as well as neuroimaging technology to evaluate measures of cognitive, social and emotional functioning. Other studies of early childhood adversity have yet to examine these factors over such a long period of time, Fox said. 

“There are about 8 million infants and children who are now living in institutions around the world,” Fox said. “The study not only has policy implications for the United States, but also policy implications around the world.”