Dec 6, 2010

Effects of Institution care on adoptees

What happens when children from severely-deprived institutional backgrounds are adopted into caring families?

Many children adopted internationally have spend months or years in institutional settings. Orphanage care can, at best, be described as neglectful. There is often multiple caregivers and little consistency in care. The opportunity for a caregiver to develop a sensitive, attuned, and responsive relationship with the infant/child is limited or non-existent.

We are finding some answers to these questions bit by bit, as the English and Romanian Adoptees (ERA) Study continues to follow a group of over 300 children adopted from Romanian orphanages in the early 1990s. The ERA researchers are in the process of comparing the Romanian adoptees to non-adopted children as well as to adopted children who never had institutional care. This work is enormously time-consuming and complex, and involves repeated measurements and interviews at different ages, plus delays associated with analyzing, writing, and publishing the results of each phase of the investigation.

A recent presentation of the children’s characteristics up to age fifteen has been published by Michael Rutter and co-authors as "Deprivation-specific psycholcogical patterns: Effects of institutional deprivation" (Monographs of the Society for Research in Child Development, Serial No. 295, Vol.75, No. 1, 2010). The 252 pages of this monograph are absolutely packed with information.

An aspect of the monograph that will be of interest to many is the question raised in the title: whether there are psychological patterns that follow severe social and other deprivation in early life. The ERA investigated a group of characteristics that seemed more likely to occur in post-institutional children than in other adoptees. The following items were included:

1. Quasi-autism: A behavior pattern not identical with autism, but including rocking, self-injurious behavior like hair-pulling, unusual and exaggerated sensory responses, and tantrums in response to changes in routine, as reported in parent interviews (Gindis, B. [2008]. Institutional autism in children adopted internationally: Myth or reality? International Journal of Special Education, 23, 118-123).

2. Disinhibited attachment, as shown in unusual friendliness toward strangers and failure to show strong preferences for familiar people in threatening circumstance. The monograph describes disinhibited attachment as including “inappropriate approach to unfamiliar adults, a failure to check back with a caregiver in unfamiliar settings, and willingness to accompany a stranger and wander away from a familiar caregiver. It is often associated with a lack of appropriate physical boundaries, so that children may interact with strangers intrusively and even seek out physical contact… there is sometimes inappropriate affectionate behavior with strangers and undue physical closeness” ( Monograph, p. 58) .

3. Cognitive impairment, including problems with “mentalization” or the ability to understand what other people might believe or feel about a situation.

4. Inattention and overactivity similar to attention-hyperactivity disorders.

While by no means all children who had come from institutions displayed these problems, even those who had spent more than 6 months in a Romanian orphanage, the ERA group reported that over 90% of those who still showed the behaviors at age 15 had spent more than 6 months in severe deprivation. Those who persisted to age 15 with these problems had often improved (for example, become more likely to be helpful or comforting to others), but odd behaviors still occurred. Some children “annoyed other people but did not know why, and difficulties making or keeping friends were common… In a few cases, … inappropriate remarks included excessively outspoken sexualized use of language” ( Monograph, p. 86). Some children were reported as fascinated with collections, including those of “useless rubbish” like chocolate wrappers.

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