Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project

Abstract

Early institutional care is associated with long-lasting adverse outcomes across neurodevelopmental, cognitive, socioemotional, and physical health domains. However, less is known about how resilience emerges following this type of severe neglect. In this review, we define resilience as a descriptive inference reflected in better-than-expected adaptation following adversity among individuals exposed to comparable adversity, and we argue that progress in resilience science requires designs that can test causal mechanisms. We highlight how the randomized foster care intervention in the Bucharest Early Intervention Project (BEIP) provides rare causal evidence on modifiable processes that support resilience following early institutional rearing. Drawing on BEIP findings, we synthesize evidence that improving early caregiving environments leads to more favorable developmental outcomes during childhood and adolescence in multiple domains, while also illustrating that recovery is partial and not uniform across domains. We conclude with key lessons learned about resilience from the BEIP and outline future directions leveraging adult and intergenerational follow-up data to refine how resilience is defined, measured, and mechanistically explained in the context of severe early neglect. By leveraging rare experimental evidence, the BEIP provides a blueprint for identifying modifiable mechanisms through which early intervention can shape resilience across the lifespan following early adversity.