Study Title: Ethical considerations in international research collaboration: The Bucharest Early Intervention Project
Authors: Zeanah, C.H., Koga, S.F.M., Simion, B., Stanescu, A., Tabacaru, C., Fox, N.A., Nelson, C.A., & the BEIP Core Group
Abstract: The Bucharest Early Intervention Project (BEIP) is the first ever randomized controlled trial of foster care as an alternative to institutional care for young children. It involved a collaboration between American investigators and Romanian health and child protection professionals. We present a brief description of the Romanian context and the project itself before discussing a number of ethical issues raised by the project. Organized around a discussion of exploitation, risk/benefit ratio, and cultural sensitivity, we evaluate a number of ethical issues involved in the BEIP using the Ethical Clinical Research Framework and the Fair Benefits Framework. Based on this review, we conclude that notwithstanding challenging ethical dilemmas, the benefits of the project outweighed its risks. Throughout the planning and implementation of the project, ethical issues were a central focus of discussion among the investigators and in the collaboration between Americans and Romanians. Thoughtful discussions from multiple perspectives are necessary to conduct research that is ethically sound and scientifically meaningful.
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Study Title: Attachment in institutionalized and community children in Romania
Authors: Zeanah, C.H., Smyke, A.T., Koga, S.F.M., Carlson, E., & the BEIP Core Group
Abstract: This study examined attachment in institutionalized and community children 12–31 months of age in Bucharest, Romania. Attachment was assessed using ratings of attachment behaviors and ratings of caregiver descriptions in a structured interview. As predicted, children raised in institutions exhibited serious disturbances of attachment as assessed by all methods. Observed quality of caregiving was related to formation and organization of attachment in children living in institutions. These results held even when other variables, such as cognitive level, perceived competence, and quantitative interaction ratings, were controlled for. Ratings of attachment behavior in the Strange Situation and caregiver reports of signs of Reactive Attachment Disorder converged moderately. The implications of these findings for different perspectives on attachment are discussed.
[button link=”http://www.ncbi.nlm.nih.gov/pubmed/16149999″ color=”lightblue” newwindow=”yes”] Read More[/button]
Study Title: A comparison of the electroencephalogram between institutionalized and community children in Romania
Authors: Marshall, P.J., Fox, N.A., & the BEIP Core Group
Abstract: Electroencephalographic (EEG) data were collected from a sample of institutionalized infants and young children in Bucharest, Romania, and were compared with EEG data from age-matched children from the local community who had never been institutionalized and who were living with their families in the Bucharest area. Compared with the never-institutionalized group, the institutionalized group showed a pattern of increased low-frequency (theta) power in posterior scalp regions and decreased high-frequency (alpha and beta) power, particularly at frontal and temporal electrode sites. This finding is consistent with EEG studies of children facing environmental adversity and children with learning disorders. The institutionalized group also showed less marked hemispheric EEG asymmetries than the never-institutionalized group, particularly in the temporal region. The results are discussed in the context of two models: that the pattern of EEG in the institutionalized children reflects a maturational lag in nervous system development, or that it reflects tonic cortical hypoactivation.
[button link=”http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8624.2005.00894.x/full” color=”lightblue” newwindow=”yes”] Read More[/button]
Study Title: Designing research to study the effects of institutionalization on brain and behavioral development: The Bucharest Early Intervention Project
Authors: Zeanah, C.H., Nelson, C.A., Fox, N.A., Smyke, A.T., Marshall, P., Parker, S.W., & Koga, S.
Abstract: This paper provides an overview of the largest longitudinal investigation of institutionalized children less than 2 years old ever conducted. The Bucharest Early Intervention Project is an ongoing randomized controlled trial of foster placement as an alternative to institutionalization in abandoned infants and toddlers being conducted in Bucharest, Romania. In addition to describing the contexts in which this study is imbedded, we also provide an overview of the sample, the measures, and the intervention. We hope that the natural experiment of institutionalization will allow us to examine directly the effects of intervention on early deprivation. We hope it will provide answers to many of the critical questions that developmentalists have asked about the effects of early experience, the timing of deprivation, and the ameliorating effects of early intervention and provide clues to which underlying neurobiological processes are compromised by, and resilient to, dramatic changes in early experience.
[button link=”http://journals.cambridge.org/action/displayFulltext?type=1&fid=187228&jid=DPP&volumeId=15&issueId=04&aid=187227″ color=”lightblue” newwindow=”yes”] Read More[/button]
Study Title: International adoption: Implications for early intervention
Authors: Johnson DE, Dole K
Abstract: A total of 56 children adopted from Eastern Europe and the former Soviet Union were evaluated in 2 international adoption clinics. Preadoptive medical records were available for 47 of these children. Results: “Children had 1 month of linear growth lag for every five months in an orphanage. Developmental delays were also common (gross motor delays in 70% of children, fine motor in 82%, language in 59%, and social-emotional in 53%). Overall, children fell behind 1 month of linear growth for each 3.4 months in the orphanage. All children in this study lived in institutional care, either orphanages or hospitals. Avg. age was 28.3 months.
[button link=”http://www.peds.umn.edu/iac/prod/groups/med/@pub/@med/documents/asset/med_49295.pdf” color=”lightblue” newwindow=”yes”] Read More[/button]
Study Title: The health of children adopted from Romania
Authors: Johnson DE, Miller LC, Iverson S, Thomas W, Franchino B, Dole K, Kiernan MB, Georgieff MK, Hostetter MK
Abstract: This comes from our initial article on Romanian adoptees which clearly showed that children lost one month of linear growth for each month they were institutionalized based on growth lag (chronological age minus height age). Sixty-five Romanian adoptees who were brought to the United States during a 12-month period beginning in October 1990; only 15% were judged to be physically healthy and developmentally normal. Infants’ length, weight, head circumference, and weight-for-height were adversely affected by institutionalization. Older children’s height was reduced. Only 10% of children older than 12 months were developmentally normal. The orphanage environment had a clear and adverse effect on growth during infancy.
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Study Title: IQ of Children Growing Up in Children’s Homes: A Meta-Analysis on IQ Delays in Orphanages
Authors: Marinus H. van IJzendoorn, Maartje P. C. M. Luijk, Femmie Juffer
Abstract: In this meta-analysis of 75 studies on more than 3,888 children in 19 different countries, the intellectual development of children living in children’s homes (orphanages) was compared with that of children living with their (foster) families. Children growing up in children’s homes showed lower IQ’s than did children growing up in a family (trimmed d = 0.74). The age at placement in the children’s home, the age of the child at the time of assessment, and the developmental level of the country of residence were associated with the size of the delays. Children growing up in children’s homes show a substantial lower level of IQ (average IQ of 84) than their peers reared in (foster) families (average IQ of 104), and the difference amounted to 20 IQ points. More research is needed to detect the causes of the large IQ delays and to test ways of improving the intellectual development of millions of children in orphanages around the world.
[button link=”http://muse.jhu.edu/journals/mpq/summary/v054/54.3.van-ijzendoorn.html” color=”lightblue” newwindow=”yes”] Read More[/button]
Study Title: Care arrangements of AIDS orphans and their relationship with children’s psychosocial well-being in rural China
Authors: Hong Y, Li X, Fang X, Zhao G, Zhao J, Zhao Q, Lin X, Zhang L, Stanton B
Abstract: There is an estimated 100,000 children orphaned by AIDS in China, but data on the care arrangement of these orphans are limited. In this study, we examine the relationship between AIDS orphans’ care arrangement and their psychosocial well-being among a sample of AIDS orphans in rural China. A total of 296 children who lost both parents to AIDS participated in the study, including 176 in orphanages, 90 in kinship care and 30 in community-based group homes. All participants completed a cross-sectional survey assessing their traumatic symptoms, physical health and schooling. Data reveal that the AIDS orphans in group homes reported the best outcomes in three domains of psychosocial well-being, followed by those in the orphanages and then the kinship care. The differences in psychosocial well-being among the three groups of children persist after controlling for key demographic characteristics. The findings suggest that the appropriate care arrangement for AIDS orphans should be evaluated within the specific social and cultural context where the orphans live. In resource-poor regions or areas stricken hardest by the AIDS epidemic, kinship care may not sufficiently serve the needs of AIDS orphans. Community-based care models, with appropriate government and community support preserving the family style and low child-to-caregiver ratio may constitute an effective and sustainable care model for the best interest of the AIDS orphans in developing countries.
[button link=”http://www.ncbi.nlm.nih.gov/pubmed/20587602″ color=”lightblue” newwindow=”yes”] Read More[/button]
Study Title: Parent-Reported Executive Functioning in Postinstitutionalized Children: A Follow-Up Study
Authors: Emily Merz, Robert McCall, Victor Groza
Abstract: This study compared parent-rated executive functioning (EF) in 6- to 18-year-old children adopted from psychosocially depriving institutions to that in children adopted from severely or “globally” depriving institutions. Individual continuity in EF over 2 years was examined in children adopted from psychosocially depriving institutions. There were 471 children adopted from psychosocially depriving Russian institutions that provided adequate physical resources but failed to provide a consistent set of responsive caregivers. There were 111 children adopted in the early 1990s from globally depriving Romanian institutions that were characterized by physical deprivation as well as profound psychosocial neglect. Adoptive parents completed a background questionnaire and the Behavior Rating Inventory of Executive Function (BRIEF). Children adopted from globally depriving institutions had significantly higher levels of EF difficulties than children adopted from psychosocially depriving institutions. For both groups, adoption after 18 months of age was associated with higher levels of EF difficulties. Children adopted from globally depriving institutions had higher levels of EF difficulties than the BRIEF standardization sample at younger ages at adoption. There was moderate to strong continuity in EF difficulties over 2 years in children adopted from psychosocially depriving institutions. These findings suggest that more severe early deprivation may lead to a higher risk of later EF difficulties, which may persist over time.
[button link=”http://www.tandfonline.com/doi/abs/10.1080/15374416.2013.764826″ color=”lightblue” newwindow=”yes”] Read More[/button]
Study Title: Maltreatment experiences and associated factors prior to admission to residential care: A sample of institutionalized children and youth in western Kenya
Authors: Gillian Morantz, Donald Cole, Samuel Ayaya, David Ayuku, Paula Braitstein
Abstract: This study aims to determine the prevalence of maltreatment experienced by institutionalized children prior to their admission to Charitable Children’s Institutions (orphanages) in western Kenya, and to describe their socio-demographic characteristics, reasons for admission, and the factors associated with prior experiences of maltreatment.
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