millions of children worldwide, living in orphanages or other institutions
where they are deprived of the warmth and attention of caring adults is not a
benign experience, a growing body of scientific evidence suggests.
studies report that spending as little as six months in an institution where
the care is extremely substandard can have a lasting developmental impact on
children, including problems forming healthy attachments and deficits in
neurological and cognitive abilities and physical growth. The research also
suggests that the children who are the most vulnerable tend to be those whose
experience in institutions comes early in life.
findings have implications for a broad range of nations, including nations
where children in institutions are rare, such as the United States. While the
studies may focus on institutionalized children, the factor found to most
influence whether they experience developmental deficits is common among all
nations, affluent or otherwise.
appears the quality of caregiver-child interactions is the most crucial," said
Robert McCall, Ph.D., co-director of the University of Pittsburgh Office of
Child Development (OCD). “And that can characterize children in all kinds of
risk circumstances—from extreme poverty to neglectful and abusive families to
as 8 million children live in orphanages, hospitals or other residential
institutions throughout the world. Although conditions vary from institution to
institution and country to country, the quality of daily care many children
receive is often less than sufficient in terms of promoting healthy
characteristics of institutions can affect the quality of care children
receive. Among those most often found are high child-caregiver ratios, large
group s, many different and changing caregivers, and the way caregivers
perform their caregiving duties, which are often described as businesslike, perfunctory,
and lacking the level of interaction, sensitivity and warmth a child would be
expected to receive in a well-functioning family.
outcomes are also affected by other factors, including genetics, prenatal
conditions, such as a mother’s drug or alcohol use, and low birth weight and
other birth complications. Another factor can be children’s experience before
they entered an institution, such as whether they were victims of abuse or
neglect within their own family.
however, substantial evidence to suggest that children’s experiences while in
an institution significantly contribute to higher rates of developmental
deficiencies. This evidence includes studies that show children improve in
every domain after they leave an institution and are placed in some type of
family care. Other studies, including OCD’s work in Russian orphanages, suggest
that children’s development profoundly improves when interventions succeed in
improving the institutional environment in which they live.
its international colleagues, with funding from the Society for Research in
Child Development and Leiden University, convened 25 of the world’s leading
experts on children deprived of permanent parents in a conference held at
Leiden University, the Netherlands, in 2009. Publications that emerged from the
project detail the developmental issues researchers have found among those
children, particularly those who spend time in orphanages or other
few decades have seen heightened interest in the development of children
without permanent parents. Much of the research on developmental issues has
involved institutionalized children, their development while in orphanages or
institutions, as well as after they are removed from the institutions and
placed with adoptive families and, in some cases, in foster care.
an opportune topic. A fundamental question in research on child development is:
What are the necessary and sufficient early experiences that children need to
develop typically? And the other side of that is avoiding long-term
developmental deficiencies.” Dr. McCall said.
the institutions in the world are not ideal environments for children. This
represents a natural circumstance of children not getting what parent-reared
children normally get and what the consequences of that are.”
attachment is one of the most profound long-term developmental problems that
have been found among some children who have spent time living in orphanages
and other institutions around the world. Contributing to the problem is the
fact that even in institutions that provide a relatively clean environment and
adequate medical care and nutrition, children are exposed to many different
caregivers who work rotating shifts and go about their duties in a businesslike
manner that lacks the warmth, sensitivity, and attention a parent would be
expected to provide—all of which makes forming stable child-caregiver
studies that assessed the attachment of institutionalized children to a
favorite caregiver using the Strange Situation Procedure suggest that, on
average, 73 percent of children exhibit insecure disorganized attachment
behavior. In one study, OCD researchers and their St. Petersburg colleagues
reported that as many as 85 percent of Russian orphanage children showed
disorganized attachment behavior. Although interventions improved care and
children’s outcomes, including attachment problems, 60 percent of the children
were still classified as having attachment disorders.
in institutions are also more likely to show indiscriminately friendly behavior
than children raised in families, who typically are apprehensive when they meet
strangers. In some cases, institutionalized children who are later adopted
continue to show indiscriminate friendliness toward strangers, even after they
become attached to their adoptive parents.
inadequate social-emotional and caregiver-child relationship environments often
found in orphanages and other institutions around the world can also result in
deficiencies in physical growth. Studies have found that institutionalized
children tend to be underd even when they are provided with adequate
nutrition and medical care.
suggests, however, that their growth tends to improve markedly when they leave
the institution, particularly if they are adopted or placed in foster care
before they the age of 1 or 2 years. OCD and St. Petersburg researchers also
report that the growth of institutionalized children in Russia improved when
the psychosocial environment of the orphanages improved.
concern is brain development, which studies suggest can be affected by the kind
of deprived environment found in many orphanages or other institutions. Researchers
report there is less metabolic, physiological, and neurochemical activity in
the brains of mid-childhood-aged children who have lived in a severely
deficient institution compared to children raised in families.
is abnormal development of parts of the brain associated with higher cognitive
functions, memory, and emotion. Some studies find that impulse control,
attention and social relations are mildly impaired among institutionalized
children who were later adopted or placed in some other family-care situation.
in brain development may also be related to problems seen among some formerly
institutionalized children in areas such as emotional regulation and executive
functioning, which is a set of cognitive processes that is important to
performing activities ranging from planning and organizing to paying attention
to details and remembering details.
some good news for children fortunate enough to be adopted by parents able to
give them a typical family environment. After they leave orphanages or other
institutions they tend to show significant improvement in terms of their
physical growth, attachment and cognitive and behavioral development.
adopted at later ages do not always completely catch up, however. For example,
even after living for several years with their adoptive parents, some children
may still be slightly underd, score slightly below expectations on general
mental tests, have attachment difficulties, and problems with attention, rule
following, planning and other activities related to executive functioning.
Early years are critical
suggest that children are the most vulnerable to experiencing development
problems if they are exposed to deprived environments in orphanages or other institutions
during their first few years of life.
example, the frequency of long-term problems among children who are adopted
from institutions tends to be different. Those who are adopted earlier in life
are less likely to exhibit problems than those who are adopted at a later age.
several studies that looked at children adopted at different ages during the
first three years of life report that there seems to be an age-related step at
which point long-term problems with behavior, executive function, and social
skills are triggered. The age at which the step occurs varies depending on the
severity of the orphanage experience and other factors. Children adopted before
the step generally have rates of problems similar to children who have never
been institutionalized. The rates of problems increase significantly when the
step occurs among children who are living in institutions. But the rates of
problems tend not to rise beyond that point, regardless of how much longer a
child stays in the institution.
would think that the longer a child is in an institution the worse the
outcomes. For some outcomes, that may be true to a certain extent, especially
social outcomes and language. But for behavior and executive functioning
problems, there seems to be a step function,” said Dr. McCall.
clear that the earlier children can be placed in a family-care situation
outside of an institution the better. Studies also suggest that interventions
resulting in warmer, more responsive, and developmentally friendly care improve
the outcomes of children who remain in institutions. But such steps are beyond
the reach of many nations that have underdeveloped child welfare or lack
adequate community-based resources to meet the complex needs of children without
parents. “We know what works scientifically and from the standpoint of
practice,” said OCD Co-director Christina Groark, Ph.D. “It’s implementing it
that is a challenge.”