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The Bucharest Early Intervention Project

*Boston Children's Hospital- Division of Developmental Medicine, Laboratories of Cognitive Neuroscience
*Tulane University
*University of Maryland
*Romanian Collaborators

The Bucharest Early Intervention Project (BEIP) was a randomized controlled trial of foster care as an intervention for children abandoned at or around the time of birth and placed in one of six institutions for young children in Bucharest, Romania (Zeanah, et al., 2003).

The BEIP began in 2001 with a comprehensive baseline assessment of 136 children and their caregiving environments. Following this assessment, half the children were randomly assigned to high-quality foster care (designed specifically for this study) and the other half to remain in institutional care. The average age at entry into foster care was 22 months (range=6-31 months). All children were seen for follow-up assessments at 30, 42 and 54 months, and again at 8 years, and the development of children in foster care was compared to the development of children randomized to remain in institutional care and to a group of never institutionalized children (community controls).

We have found in data collected on children through 54 months of age that early institutionalization leads to profound deficits and delays in cognitive (i.e., IQ) and socio-emotional behaviors (i.e., attachment), a greatly elevated incidence of psychiatric disorders and impairment, and differences in brain electrical activity. Our foster care intervention was broadly effective in enhancing children’s development, but for specific domains of neural activity (EEG), language, cognition and social-emotional functioning there appear to be sensitive periods regulating their recovery (see Relevant Publications below). That is, the earlier a child was placed in foster care, the better their recovery. Although the sensitive periods for recovery vary by domain, our results suggest that placement before the age of 2 years is key.

Preliminary findings from the assessment at 8 years suggest that children assigned to remain in institutional care continue to demonstrate profound delays in nearly all domains we have examined. Also, in a few domains we are now seeing that children placed in foster care look very similar to never-institutionalized (community) children – that is, they are showing complete “recovery.” Finally, in other domains this is not the case – that is, children placed in foster care are situated at the midpoint between children that remained in institutional care and community children. This is true for specific domains of attachment, emotional responsiveness, anxiety disorders, and IQ. This suggests that in these domains their recovery has hit a ceiling. We will continue to examine these data to determine whether our intervention has more lasting effects, to explore additional sensitive periods in recovery and to identify mechanisms associated with such recovery in cognitive, social, and psychological development.

We are currently planning another follow-up assessment with these children as they enter into early adolescence, another critical transition in development.

The BEIP is supported by the John D. and Catherine T. MacArthur Foundation, the Sinneave Family Foundation and the Binder Family Foundation.

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To learn more about the Bucharest Early Intervention Project and view a full list of publications, please visit our new website, here.

Research Description

We are starting an exciting project introducing a neuroimaging toolkit in rural and urban Bangladesh to study brain structure and function in infants and toddlers. Our two-year project funded by the Bill and Melinda Gates Foundation is a collaboration between Harvard Medical School and Boston Children’s Hospital, University of Virginia, University College London, and the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).

We will be using functional near infrared spectroscopy (fNIRS), electroencephalograms (EEG) and magnetic resonance imaging (MRI) to study the association between exposure to early adversities (e.g., biological, environmental, psychosocial) and brain development in children of Bangladesh. The combination of these imaging techniques along with other behavioral assessments (Mullen Scales of Early Learning, various cognitive function tests) will provide a much-needed data base on early brain and cognitive development in a low resource region of the world of data on brain function and structure within existing populations.

Although previous research in low-income settings have used coarse behavioral measures to gauge development, using imaging and behavioral assessments provides us with a robust set of tools that are portable, low-cost methods of assessing cognitive development, which can potentially be deployed globally, particularly in low resource settings where adversities are abundant.

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