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A mother and her children walk through the grounds of St. Catarina's orphanage in Bucharest. The orphanage used to house a thousand children who now have been reunited with families or sent to foster care or small-group homes. The orphanage now houses The Bucharest Early Intervention Project lab as well as a recovery center where former residents of the orphanage return for various therapies. - photo by Sasha Aslanian

American researcher Charles Nelson and his team visit a small group home for orphaned children in Bucharest, Romania. They open an iron gate into a play yard and a disabled boy and girl rush down the path to greet them. The girl, who looks about 7 years old, holds out her arms for a stranger to pick her up. The translator yells not to pick her up, but it's too late. The girl doesn't cuddle or appear comforted by the contact. She holds her body rigid, as if she's clutching a tree trunk.

Nelson explains it's called "indiscriminate friendliness," a common problem for kids raised in institutions. "They just walk right up to you and want to be picked up," says Nelson. "What [our translator] was saying was not to pick her up because the last time that happened, when they put her down, she just threw herself down on the ground and kept hitting her head, which is probably a way for her to deal with rejection or something like that."

Charles Nelson is a researcher at Harvard University who studies brain deprivation - what happens when infants and young children don't get what they need from others. Romania has provided him with a natural experiment.

This photograph taken in February 2001 shows children raised in the neuropscyhiatric ward of an orphanage. The boys are 15 to 20 years old. - photo by Susan Parker

On his laptop, Nelson shows a video of three Romanian boys who grew up in an orphanage. The three boys are sitting around a table. Two sit on chairs and their legs can't reach the floor. A third perches on a caregiver's knee. Nelson asks, "Now looking their size, how old do you think these kids are?" I guess 6. "Yeah" Nelson agrees. "These kids all look to be about 5 or 6, but are actually 15 to 20 years old. That gives you an example of what happens long-term in the growth stunting."

Nelson explains it's not from lack of nutrition. The boys got enough to eat. But their bodies didn't produce enough growth hormone. The theory is that in a stressful environment, like growing up in a place where no adult pays attention to you, the body conserves energy for brain development. But even with that conserved energy, Nelson says the children's IQs were almost 40 points lower than average. He says, "The fact that their IQ is as low as it is, which we don't think is genetic in origin, is due to the profound intellectual deprivation that they experience in the institution."

Nelson says early experiences like having a loving adult talk to you, play with you, and comfort you, are key to shaping the brain. "If you're exposed to the wrong experiences or you have no experiences, such as what occurs in deprivation, then the brain kind of gets miswired," Nelson explains. "The concern we have from a neuroscience perspective is if it is miswired early on for an extended period of time, it may be very difficult later on to rewire it." Nelson says Romania's abandoned children created an opportunity to learn how much rewiring was possible at different ages.

Charles Nelson is a professor of Pediatrics at Harvard Medical School who researches the effects of social deprivation on the brain. - photo by Sasha Aslanian

He and his colleagues started The Bucharest Early Intervention Project in 2001.

They got funding in the United States and the Romanian government allowed them to remove 66 children from orphanages and place them in high-quality foster care. At the time, Romania had no foster care, so the researchers had to recruit and train the foster families themselves. The 66 children were from 6 months to 2 1/2 years old. For five years, researchers tracked their progress against children who remained in the institution and a control group of Bucharest kids growing up with their own families.

There were two important ethical considerations. First, any child sent to foster care would never be returned to the institution; and second, any child in an institution who found a family would not be prevented from leaving.

Nelson says the changes they witnessed among children sent to foster care were dramatic. He demonstrates with three video clips.

In the first clip, a little girl tries to stand on a blanket outside the orphanage. The dark haired toddler has the wobbly look of a 1-year-old, but she's almost 2. Nelson narrates, "You watch her and she falls and she's floppy and can barely stand. And notice the caregiver thinks this is funny and has walked away from the child. The child continues to scream for attention but nothing happens." The orphanage worker begins to sing a loud song and clap, not soothe the baby. The baby cries and crawls backwards off the blanket where the woman eventually scoops her up.

The girl has no language, and an IQ under 50 - way below normal.

The little girl is placed in foster care. Eight months later, she's 30 months old and the videotape shows she's progressing more rapidly than the kids in orphanages. Nelson says, "Notice here she is talking pretty fluently, playing with her foster care mom. She looks quite good there. Now notice that she's walking better and will sit down and play with her foster care mom. Notice the kind of relationship she has with the foster-care mom."

The foster mom is sitting down on the living room floor with the girl. She touches her frequently, makes eye contact, and cheers when the girl throws a plastic ball.

Another year goes by in foster care and the little girl is now 3 1/2. She's videotaped this time carrying on an animated conversation with her foster mother while tying the strings on a doll's outfit. Her IQ has risen to 82. That's still below normal, but she's much higher functioning than before.

The children in Charles Nelson's study are now 5 to 7 years old. Nelson goes to visit 5-year-old Florin who lives across town in a typical Soviet-style apartment block.

The boy sits cautiously on the couch eyeing the group of strangers assembled in his family's living room.

Five-year-old Florin was placed in foster care when he was 11 months old. His foster mother has now adopted him. Here he shows off a card he has made for her that reads, "Mommy, I love you dearly." - photo by Charles Nelson

Nelson is pleased to see the boy differentiate between family and strangers. "If he had just climbed into my lap right now, I would really get worried because that would be a sign of indiscriminate friendliness." Florin wants to show off his artwork. He's made a card for his mother and written, "Mommy, I love you dearly."

Florin was randomly assigned to his foster mom when he was 11 months old. At that point, he couldn't sit up, something most babies do at 6 months. Nelson agrees, "At 11 months, not sitting up is behind. But my intuition is he made up for lost time quickly." He turns to Florin's mother and asks, "When did he sit up?" She responds that he could sit up at 12 months and walk by 14 months.

Nelson nods enthusiastically. "So he caught up quickly. And that's sort of our experience. When you put kids who have been institutionalized into good foster care, they rapidly catch up."

Kids like Florin who left the orphanage when they were still under 1 year did especially well. The foster kids' IQs rose an average of 10 points and they had less depression and anxiety than the children who stayed in institutions. However, rates of Attention Deficit Hyper-activity Disorder didn't improve. And Nelson's team was puzzled by other problems that didn't go away. "These kids got longer, they got taller, they weighed more, but the head circumference didn't change for the kids we placed in foster care," says Nelson.

Their heads stayed small, and their brain activity wasn't as vigorous as it was in the kids who'd never been institutionalized. It was a worrisome finding. Nelson says, "I was surprised given the changes in behavior that we weren't seeing these changes in brain and we have to think about that. There could be a profound reason for that. That in a sense, these kids may never fully recover." Or, Nelson wonders, will more years in foster care finally close the gap?

The Bucharest Early Intervention Project will follow the children until they are 7 to 9. The researchers want to do brain scans to look deeper into the brain structure, not just the brain activity of the children. They'd like to add genetic analysis to see if certain genes influence recovery.

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Nelson says the data his team has gathered demonstrate there are sensitive periods in early childhood for specific kinds of crucial development. Head size grows in the first year, age 2 is critical for language, and cognitive development probably has a longer window.

Nelson says day-to-day family life gives babies what they need in all these areas. "The normal things that exist in the world, to see and hear and talk be touched and talked to, are probably sufficient for most kids." He continues, "The kids it's not sufficient for are kids who lead lives of deprivation early on. They do need a super-duper environment."

The bottom line is kids do best in families, whether created through birth, adoption or foster care. Nelson says institutions canít replace the individual attention and stimulation of family life. He hopes that other countries with orphanages - in Eastern Europe, Asia and Latin America - will be persuaded by the science too.


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