Foster care helps neglected children be more resilient, healthy

Neglected children who are placed with foster care families earlier in life are more likely to be just as resilient and competent socially, academically and physically as their peers who have never been institutionalized when they reach their teenage years, according to new Stanford research focused on children in Romania.

Researchers found that 56 percent of previously institutionalized children who were randomly placed with foster care families when they were between 6 months and 2 and a half years old were as competent across a range of metrics as their peers at 12 years old. This is more than double the percentage of those children who remained in institutional care, of which only 23 percent were deemed to be competent at age 12, according to the study, published Feb. 1 in the Journal of Child Psychology and Psychiatry.

The number of children who met the researchers' threshold for competent outcomes was even greater among children placed in family care at young ages. Of those children age 20 months and younger at the time of placement, 79 percent were deemed competent. This is nearly the same rate as children who were never institutionalized.

"This study proves that resilient outcomes can be promoted by placing kids into foster care earlier in life," said Kathryn Humphreys, a Stanford postdoctoral scholar in psychology and a lead author on the study. "These kids are not doomed, and many of them end up with normal outcomes. So it's important for us to work on removing them from those neglecting environments as soon as possible."

A worldwide concern

There are about 8 million orphan children in the world, and this new research can help inform the debate over how best to take care of them, Humphreys said. In the United States, where institutional care is less common than in other places, neglect is still the most common reason for child maltreatment cases reported with child protective services around the country. Recognizing cases of neglected children and placing them into positive foster care environments is something even developed countries need to strive for, Humphreys said.

The study evaluated children who have been part of a long-term randomized, controlled trial in Romania, called the Bucharest Early Intervention Project, which started in 2000.

Previous research on orphanages and other early institutional care has shown that children in institutions experience severe psychosocial deprivation, leading to long-term developmental challenges. Adding to that, the Bucharest project found that children who were institutionalized longer early in life had poorer IQ scores and mental health.

Assessing resilience

The new study is unique because it takes a broad approach to analyzing children's functioning, said Humphreys, who conducted the research during her postdoctoral fellowship at the Tulane University's School of Medicine and continued the work at Stanford, where she is working with Professor Ian Gotlib in the Department of Psychology.

Researchers assessed the children's level of resilience to early deprivation across seven categories of well-being: family relations, peer relations, academic performance, physical health, mental health, substance use and risk-taking behavior. If a child scored positively in six of seven categories, they were deemed to meet the threshold of adaptive-functioning.

"There is no one metric of resilience," Humphreys said. "But this was our way of using the existing available data to measure how well children are doing relative to their peers."

Humphreys said one finding that surprised her and other researchers is that 40 percent of all children who ever experienced institutionalized care met their threshold for resilience.

"When we think about kids in institutional care, we often think about how they end up not faring well," Humphreys said. "This research gives us a different, hopeful lens. A lot of kids seem to be doing just as well as their peers. It also gives us a window into how to promote resilience in children who experience neglect – namely, placing them in family care as early as possible."

Researchers hope to continue assessing the development of children as part of the Bucharest project as they grow and reach adulthood.