Orphanage Risk Factors

Risk Factors for Institutionalized Children

http://www.davevincent.com

 

 

 

 

 

 

 

We say that children raised in secure attachment have the best chance at a healthy, happy and successful life – they are mostly likely to reach their best potential with healthy bodies, secure and supportive relationships, having confidence that they will realize dreams.  Victor Frankl also suggests that we also say that those who suffer learn/experience a deeper humanity and Proust said, “We are healed of suffering only by experiencing it to the full” (Coyote Healing: miracles in native medicine, 213).  So orphanage risk factors? Helpful or Hellish?

I have read a fair few books, written by people I respect, dealing with risk factors for children.  Because my son was adopted from Russia, I have primarily focused on books that refer to orphanage risk factors in Russian orphanages.  But I have also read books and articles dealing with institutional care risk factors from many other parts of the world, the western world not excluded.

A typical example referencing the role of institutional care would be the following:  … ‘“failure to thrive” [is] a well-known syndrome in abused and neglected children, especially those raised without enough individualize nurturing and attention.  The condition has been documented for centuries, most commonly in orphanages and other institutions where there is not enough attention and care to go around.… The children who survive such emotional deprivation – like the recent Eastern European orphans…. often have severe behavioural problems, hoard food, and may be overly affectionate with strangers while having difficulty maintaining relationships with those who should be closest to them”’ (The Boy Who Was Raised As A Dog, 95). But then I recently read Paris Hilton’s memoir of her time in a ‘troubled teen’ facility in the USA (Paris: the memoir, 2023). Aspects of her treatment there can be found in many of the other books and articles I have read.

Furthermore,  focus on the orphanage issues must ultimately be placed within the context of age of the child at entry to the orphanage, while in the orphanage and at exit from the orphanage, as well as the child’s pre-orphanage bio-psycho-social issues. And while acknowledging the similarities in care world-wide, the differences in institutional care globally cannot be ignored either.

I am presenting a random offering from a far larger body of work on orphanage risk factors, and using only material for which I have an address. I offer the material’s address and a summary which I hope, given that this is a personal study, complies with copyright policy.  I have a copy of each article if readers need one.

Reading the Child Catchers, Somewhere Sisters, Ghosts of the Orphanage, China’s Hidden Children, Before and After and The Adoption Machine, I recognize this is not an issue only in the countries mentioned in these books and articles (Mothers of Misery suggests Russia was just slower to move in that direction), but rather a global concern that some countries have had, are currently dealing with, and others have yet to deal with.

J.K. Rowlings has discouraged students making plans for their gap year from signing up to volunteer at orphanages (volunteer tourism) for it perpetuates the problems orphanages generate (https://www.theguardian.com/global-development/2019/oct/24/jk-rowling-urges-students-not-to-volunteer-at-orphanages).

To set the stage, I begin with the questions considered by  

Adverse Childhood Experiences or ACE.

https://americanspcc.org/take-the-aces-quiz/

Stressful life events experienced by children and teens can have a profound affect on their physical and mental health. This questionnaire can assist your healthcare provider in assessing these stresses.
Item 1= Yes/0= No
1. __ A person in the household often or very often acted in a way that made the child/teen
afraid that they would be hurt (e.g., sworn at, insulted, put down, humiliated)
2.__ A person in the household often or very often hit, pushed, grabbed, or slapped the
child/teen so hard that they had marks or were injured
3.__ A person touched the child/teen’s private parts or asked them to touch their private
parts
4__. Child/teen often or very often felt that people they lived with did not love them, look
out for each other, feel close to each other, or were a source of strength and support
5.__ Child/teen often or very often did not have enough to eat or clean clothes to wear, and
did not have someone to take care of and protect them
6.__ Child/teen’s parents or guardians were separated or divorced
7.__ Child/teen witnessed a person in the household being pushed, grabbed, hit, or
physically threatened
8.__ Someone the child/teen lived with had a problem with drinking or used street drugs
9.__ Someone the child/teen lived with was depressed, mentally ill or attempted suicide
10.__ Someone the child/teen lived with served time in prison
Total:

Un-Addiction: 6 mind-changing conversation that could save a life 

Nzinga Harrison, MD with Lynya Floyd, 2024, 75-76, offers additional ACE identifiers.

1. Overall, did you feel unsafe in the neighbourhood(s) you grew up in? Did you feel like people in the neighbourhood(s) you grew up in failed to look out for each other?  Or did you see or hear someone being beaten up, stabbed, or shot?

2.Were you ever bullied by someone you didn’t live with? It could be a peer, a classmate, or an adult?

3. Did you often feel that there was no one in your life who helped you feel important or special?

4. Did you often feel that you were treated badly or unfairly because of your race, ethnicity, economic status, learning differences, or other part of your identity? This could also be your religion, gender, sexuality, or something else?

5. Were you ever in foster care?

From my stash of hard copy

Born For Love: why empathy is essential – and endangered   Maia Szalavitz and Bruce D. Perry   2010

Summary

Chapter 3 makes the point that infancy may be the time a brain is most impacted by its environment.  If the baby is at that time institutionalized, the baby brain may adapt in ways harmful to stable development and attachment. This is of particular concern if the institution is underfunded and understaffed, resulting in concerns such as higher susceptibility to illness, lower IQ, and the “hole in the heart” feeling of a lack of attachment (47–64). Language development is also hampered, adding to impulsivity as children are not encouraged to “use their words” to express frustrations as there is no one to talk to or to listen to them (194-195).

Chapter 3 deals with oxytocin’s role of relieving stress and encouraging the bonding between caregiver and infant. What oxytocin is engendered in an institutionalized child must be shared by a number of children being cared for by shift workers, however invested they are in their work. In sum a child raised in these conditions may exhibit, even when later adopted and experiencing continuous and focused care, behaviours similar to autistic interactions or may struggle with life long issues with attachment (70). Chapter 3 states: “Early experience forms the template for later life – and oxytocin guides its wiring in the case of attachment and bonding” (66).

If attaching in love is a human experience an adoptor worries might be beyond the reach of someone who begins life without their fair share of oxytocin infusions,  Szalavitz and Perry offer hope.  But “‘[l]ike an addict with a tolerance, it takes a higher “dose” to get the same effect”’ (134-136).

 The Boy Who was Raised as a Dog: and other stories from a child psychiatrist’s notebook   Bruce D. Perry, and Maia Szalavitz  2017

Summary

This book was published before and then updated after Born For Love, providing stories of children who underline how deeply inconsistent or non-existent care damages the heart, mind and body of children in the first three years of their lives (92, 93). Perry and Szalavitz bring weight to their focus on the first three years: “Another factor is the timing of the trauma: the earlier it starts, the more difficult it is to treat and the greater the damage is likely to be” (167).  The writers discus how mirror neurons work for a “sense of connectedness” (98), how the brain seeks to “match” incoming information to what it already knows about danger (47-48), how hyperarousal or disassociation are likely trauma-related (51-52), how children receive the designation ‘failure to thrive’ or “often have severe behavioral problems, hoard food, and may be overly affectionate with strangers while having difficulty maintaining relationships with those who should be closest to them” (95) or how they may come to believe that there is no one they can trust other than themselves(123) .  The writers present concerning research showing that the deprivations experienced by children in an orphanage environment,which they refer to as “splintered development”(167), hamper the growth and functions of a brain, including the development of language. “The key to healthy development is getting the right experiences in the right amounts at the right time” (152).

Unbroken Brain: a revolutionary new way of understand addiction   Maia Szalavitz   2016

Summary

If Born for Love and The Boy Who Was raised as a Dog present the challenges that thwart a healthy beginning to life, Unbroken Brain moves on to the expression of a traumatized brain  in the teen and adult life experiences. If a traumatic childhood produces a brain wired to deal with trauma as the epigenetic process turns on the genes deemed necessary to deal with trauma, then the child moves on into life “‘…wired for a future in a threatening world [which] can create a “live fast, die young” mind and body – and this increases addiction risk…. [and] can lead to impulsive choices…. Alternatively, it can create a rigid desire for control, to try to minimize the chaos“‘(66-68).

Attaching in Adoption: practical tools for today’s parents

Deborah D. Gray 2002

Summary

I believe Deborah D. Gray’s book remains a ‘go-to’ reference for adoptors.  She offers advice to adopting parents whose children do not see the difference between the relationship they had with orphanage staff and the relationship their parents seek to offer them (79). Gray provides the story of Stephen who “learned the rules, followed them when others were looking, and formed his closest relationships with other children” (33).

Here is one of Gray’s heartbreaking observations: “‘I found that among adopted children, over half of the children I asked, “Do you think that an adopted child is entitled to as much love and care as children who are not adopted?” answered, “No”, or “Not really.”’ (37).

Gray offers Foster Cline’s Checklist for Symptoms of Attachment Disorder( 81), a checklist that is not an opportunity to rush to a RAD diagnosis, a diagnosis much rarer than once thought. She also lists behavioural response to trauma for such children “organize their world as if it were hostile” (111-114), but the bulk of the book offers guidance to the parents of these traumatized children, summed up in “high nurture and high structure parenting“(61) of children with avoidant, insecure or disorganized attachment (71-76).

The Girl Behind the Door: a father’s quest to understand his daughter’s suicide

John Brooks 2016

Summary

Remembering again that many experts now caution that a RAD diagnosis is a rare diagnosis, John Brooks, in seeking to understand his daughter’s struggle in their family unit and ending her life by committing suicide, found some understanding in the “behavioural profile” associated with Reactive Attachment Disorder: emotional regulation/low tolerance for frustration and ineffective coping skills, controlling her environment as self-protection, transitions/changes in routine, struggling against discipline and poor self-image (173-174).

Hold On To Your Kids: why parents need to matter more than peers

Gordon Neufeld and Gabor Mate  2004

Summary

Chapter 17 discusses “peer-oriented” kids, another risk that develops in an institutional setting where kids spend more time with each other than with adults (235 – 253).

Understanding Attachment: parenting, child care and emotional development

Jean Mercer  2006

Summary

The book sums up what research shows in terms of policy making regarding the raising of children.  It may seem to fly in the face of some of the other material presented here but must be given a careful reading as well.

  1. Newborn infants are little, if at all, affected by separation from the biological mother.
  2. Attachment develops as a result of consistent, sensitive, responsive care, especially in the first two years. For the best developmental outcomes, foster care and nonparental day care need to be planned with foundation. 
  3. From about six to eight months and on, abrupt long-term separations are disturbing to the child and interfere with sleeping, eating, playing and learning…. but can also recover, especially if treated with sensitivity and responsiveness by new caregivers. 
  4. Adults’ attitudes about relationships strongly influence children’s attachment, and caregiver should be selected and guided in ways that help them show positive attitudes about attachment.
  5. By the age of five or six years, children are much less influenced by separation than they were as toddlers, although they will still be sad about losses. (169 -170).
Thinking Critically About Child Development: examining myths & misunderstandings   

Jean Mercer   2016

Summary

Claim #14: It’s been proved that it’s always better for parentless children to be placed in foster care rather than in orphanages or similar institutions .

The research does not clearly support … belief that institutional care for orphaned and separated children is always a cause of serious developmental problems.  Unfortunately , the research needed to draw this conclusion is quite difficult to do, and no study done yet has provide the highest possible level of evidence in one direction or another (94 – 97).

Claim #26: The time between birth and age 3 years is the most important period of development and learning in a person’s life.

The period between about 6 months and 3 years of age of age seems to be when children are most intensely affected by adoption events.  For example,  diet is important for healthy growth [d]uring the first three years or so, [yet] the problematic development of the malnourished child can be corrected to some extent if the child is given a better diet, with milk, meat, eggs or other good protein sources included.  However,  delaying the improved diet until the child is 6 years old will not have the same effect.   Studies … have not make clear whether the first three years are of overwhelmingly powerful effect or whether later interventions can be useful (155-159).

Claim #44: Adopted children have many more social and emotional development problems than do nonadopted children.

The effects of adoption depend on three highly significant factors that may be quite different for different adopted children: the child’s age at separation, the circumstances surrounding the adoption, the caregiving abilities of the adoptive parents (245-249).

Articles:

Before reading articles below that stress the plight of disabled institutionalized children, it would be good to check out Colin Farrell’s Foundation for children with Angelman syndrome and others with intellectual disabilities. The Colin Farrell Foundation seeks to provide education, awareness, advocacy, and innovative programs to support and offer community to people with these disabilities, to be there for them in adulthood. The difference in perspective on care is breath-taking.

Abandoned by the State:   Violence, Neglect, and Isolation for Children with Disabilities in Russian Orphanages 

September 15, 2014 https://www.hrw.org/report/2014/09/15/abandoned-state/violence-neglect-and-isolation-children-disabilities-russian

Summary

This article focuses on disabled children in institutions who have physical disabilities, development delay or  intellectual disabilities. They more often experience abuse and deprivation than healthy children or ‘social orphans‘.  If and when they ‘age-out’ of the system, being presented as less desirable to prospective adoptors, they may struggle with substance abuse, psychosocial issues or become involved in criminality.   These are children who may spend their entire lives in cribs or “lying-down” rooms or at the very least be offered little preparation for an adult life once they age-out of the institution.

The blame can not always be laid at the feet of the staff who may be poorly trained, however well-intentioned, nor is the state entirely uncaring. Russia set forward a strategy in 2012 to 2017 to allow disabled children to stay or return to their birth families and to encourage family care over institutional care, as well as, to seek to increase orphanage care where it was lacking.

The article, written in 2014 by the Human Rights Watch, goes on to offer to the Russian government recommendations for improving the care of disabled children and alternatives to institutional care.  Helpful definitions of key terms and institutions and types of abuse, as well as, case studies are provided. The hurdles to be faced in providing alternative care are also noted. While difficult and disheartening to read at times, Human Rights Watch ended the article or call to action with some success stories.

The Grim Face of Russia’s Orphanages; Children: Rights group documents ‘appalling’ abuse, seeks end to Soviet-style warehousing

Paddock, Richard C.  Los Angeles Times; Los Angeles, Calif. [Los Angeles, Calif]. 17 Dec 1998:

https://www.latimes.com/archives/la-xpm-1998-dec-17-mn-54995-story.html

Summary

This is a report on the “Soviet-style system of warehousing unwanted and disabled children out of sight of society and depriving them of their fundamental human rights” in Russian orphanages as depicted by Human Rights Watch in 1998. They offer suggestions for improvements:

* End the practice of encouraging parents to institutionalize disabled infants.

* Begin the development of a foster care program to take the place of orphanages;

* Halt the early diagnosis of oligophrenia.

* Establish an independent commission to investigate orphanages, with full access to the institutions and the ability to receive confidential complaints from children and staff members.

* Undertake a public education program to dispel Russians’ deep-rooted prejudice against disabled and abandoned children.

* Ensure that all children in state custody be provided with necessary medical care.

The orphanage as an institution of coercive mobility

Tom Disney, Centre for Social Work, School of Sociology and Social Policy, University of Nottingham, Nottingham, Nottinghamshire NG7 2RD, UK. Email: thomas.disney@nottingham.ac.uk Environment and Planning A 2017, Vol. 49(8) 1905–1921

Summary

The orphanage is seen in this article as a setting of “carcerality“; “firstly as a form of spatial segregation and containment, secondly as a form of punishment and finally enforced stillness and restraint as a form of care” with control the priority consideration in caring for the children. [Insert- I wonder if sitting and rocking preferred over more rambunctious activity may not be only for self comfort when no adult offers comfort. It may also be a learned behaviour when a child is ‘contained’ as an attempt to control whether for lack of staff and ostensibly to prevent self-harm or because staff either do not have sufficient training or see the child as hopeless anyway.]

As with incarceration in prison, children enter orphanages involuntarily, not always handed over to the state with informed agreement from the parents should the state see the child as impaired and needing to be removed from the general populace. Control within the institution is maintained by “social [shouting], physical [being beaten by staff] and medical forms of control [giving the children sedatives, sending the children for psychiatric treatment], restraint [tied to a chair, putting the child in a straitjacket] and immobilization“.

The Ames Study: Romanian children adopted by B.C. families: Romanian Adoption Research Project

Robin Hilborn (published in Adoption Helper, Sept. 1992, p.8)

The children didn’t have enough to eat or drink and were underweight.   Many had medical problems and were developmentally delayed…. Attachment: they were indiscriminately friendly to all adults.   

There were developmental delays in these children raised under poor institutional conditions.  They showed behaviour problems such as rocking back and forth, dislike of solids, willingness to eat enormous quantities of food.

A longitudinal study of the physical growth and health of postinstitutionalized Romanian adoptees

Lucy Le Mare, PhD and Karyn Audet, MA  Paediatr Child Health. 2006 Feb: 11(2): 85-91

Summary

Psychosocial dwarfism or growth retardation was the focus of this study of Romanian children who were documented at 11 months after adoption, at age 4.5 and then at age 10.5.  While malnutrition, infectious diseases and very limited interaction with and stimulation by staff impacted the children’s growth, the study shows that by the third point of the study the children were noted to have made good growth gains.

Behavior Problems in Postinstitutionalized Romanian Adoptees: Explanatory Parameters in the Adoptive Home   

July 2014 Merrill-Palmer quarterly (Wayne State University. Press) 60(3):245-27 DOI:10.1353/mpg,2014.0017 Authors: Lucy Lemare Simon Fraser University,Karyn N. Audet Douglas College  E-mail:lemare@sfu.ca. MP_60.3_01.indd 245 19/08/14 9:21 AM

Summary

In this study of adoptees from Romanian orphanages, Lemare and Audet focused on the length of time spent in deprivation in an orphanage and its connection to behaviour problems when these children became adolescents, finding the impact to be less if the child was adopted before 2 years old. They looked at both how attached the adoptive parents and the adoptees were to each other and how easily they were able to communicate with each other, with better attachment and communication lowering the risk of behavioural issues in adolescence.  Adopters are also often counseled pre-adoption to keep alive a connection between the child and the child’s origin culture. It is in fact, stipulated in the 1993 Hague Convention (Article 16, No. 1b). 

Their research was guided by the Child Behavior Checklist (https://www.apa.org/depression-guideline/child-behavior-checklist.pdf), Parenting Stress Index, the Attachment and Reinforcement scales, and the Inventory of Parent and Peer Attachment. The child’s age at the time of adoption, institutional experience and the child’s age at the time of the study were noted as well.  They saw that the child’s struggles are more internal when young and becoming external when the child moves into adolescence.

While the study found that behaviour problems were likely to happen among these institutionalized children at “double the 14% rate in the general population”, as in other of their studies they assure adoptors that with receptive and sensitive parenting, they may be able to help the child move with greater ease to a more stable approach to the internal struggles brought about by the child’s experience of deprivation in the orphanage.

Appendix

Communicative openness–self

  1. How comfortable are you talking about your adoption?
  2. How comfortable are you talking about your background in Romania?
  3. How comfortable are you talking about your birth mother?
  4. How comfortable are you talking about your birth father?

Communicative openness–parents

  1. How comfortable are your parents talking about your adoption?
  2. How comfortable are your parents talking about your background in Romania?

Exposure to  birth culture

  1. Read books on Romania
  2. Attended Romanian cultural events
  3. Joined a Romanian cultural group
  4. Discussed Romanian culture with parents
  5. Learned Romanian language
  6. Learned Romanian songs/stories, etc.
Further study by Lucy Lemare and Karyn N. Audet

Mitigating effects of the adoptive caregiving environment on inattention/overactivity in children ad…

March 2011 · International Journal of Behavioral DevelopmentKaryn N. Audet Lucy Lemare

Communicative Openness in Adoption, Knowledge of Culture of Origin, and Adoption Identity in Adolesc…

July 2011 · Adoption Quarterly Lucy Lemare Karyn N. Audet

Other articles

Psychological Adjustment in Intercountry and Domestic Adopted Adolescents: A Systematic Review

Oct 2017 Child Adolesc Soc Work J Raquel Barroso    Maria Barbosa Ducharne Vanessa Coelho Ana Silva

Summary

This review looks at results of 12 studies the psychological problems of adoptees as compared to non-adoptees:externalized behaviours, higher need of mental health services. Most noticeable was the relation between behaviours and the child’s age at the time of the adoption.

Specific Extreme Behaviors of Postinstitutionalized Russian Adoptees

May 2011 · Developmental Psychology Brandi N. Hawk Robert B. McCall

Behavior problems in children transferred from a socioemotionally depriving institution to St. Peter…

March 2014 · Infant Mental Health Journal

Rifkat Muhamedrahimov Varvara V. Agarkova  Elena A. Vershnina Christina J. Groark

Summary

Also using the Child Behaviour Checklist, the above two studies look at children adopted from “socioemotionally depriving” orphanages in Russia after 18 months and subsequently having behavior problems in their teens.

Increased Risk of Precocious Puberty in International Adopted Children in Denmark  Pediatrics.

2006 Aug: 118(2):e391-9.

Summary

Over concern for precocious puberty in adopted girls, the study suggests that psychosocial problems experienced by the institutionalized child, considering the child’s age at the time of adoption and the child’s origin country, and acknowledging genetic factors as well, may lead to earlier pubertal maturation, except in adoptees from Korea.

Adopted Children’s Behavioral Adjustment Over Time: Pre-Adoption Experiences and Adoptive Parenting

Apr 2019 J EARLY ADOLESCENCE Chloë Finet  Harriet Vermeer Femmie Juffer  Guy Bosmans  Child development research – publications for Feb 2015

Early deprivation and home basal cortisol levels: A study of internationally adopted children

Because this one is quite hopeful and positive I have entered the entire abstract.

We tested whether adoptive parenting played a role in the association between pre-adoption experiences and children’s adaptive (responsiveness) and maladaptive (internalizing and externalizing behavioral problems, attention and sleep problems) behavioral adjustment over time. Ten-year-old girls, adopted at 13 months from institutional care (n = 50) or foster care (n = 42) in China to the Netherlands, participated 2 months (Time 1, N = 92), 6 months (Time 2, N = 92), and 9 years after adoption (Time 3, N = 87). At Times 1 and 2, the adoptees showed significantly fewer behavioral problems in many areas than non-adopted youth, with medium to large effect sizes. At Time 3, the adoptees showed similar rates of behavioral problems as non-adopted youth, with the exception of somewhat elevated levels of internalizing problems. Pre-adoption experiences were not associated with their behavioral adjustment. Furthermore, adoptive parenting did not moderate the association between pre-adoption experiences and behavioral adjustment over time. Nevertheless, the finding that the adoptees generally did not show above-average levels of behavioral problems illustrates that adoption had a positive impact on their development.

Children in Institutional Care: Delayed Development and Resilience

Monogr Soc Res Child Dev. 2011 Dec. 76(4): 8-30 Doi: 10.1111/j.1540-5834.2011.00626.x

Summary

This article considers the validity of the suggestion that Post-Institutional Syndrome is permanent , concluding that it is safe to assume  “structural neglect” in institutional child care. Nonetheless, “some children remain resilient even in the most adverse settings”.

Structural neglect refers to the the lack of material resources, staff limits, both in training and  consistency of interactions leading to attachment issues, and the less-than-representative-of-‘family’ groupings, usually being large and homogeneous. This has been seen to result in delays in physical growth and IQ, and “dysregulation of the neuroendocrine systems“. Again the detriment of a longer stay in the institution is noted.  “That being said, there is also evidence suggesting that quality of caregiving in the post-institutional (adoptive) environment can mitigate the effects of even very lengthy institutional experience …”.

All that being said, and given the many articles on the Orphanage Risk Factors page, it is said very often, this article brings forward one particular aspect I have not encountered in other articles: the stigma attached to the idea of Post- Institutional, as in adopted child, Syndrome connected to behaviour problems exhibited by adoptees.  “The concept of “Adopted Child Syndrome” was later abandoned following criticism of its conceptual and methodological flaws…. indeed adoption is now more often perceived as a successful intervention that leads to remarkable catch-up in all domains of child development”.

Why it matters: How orphanages harm children   

The UN Global Study on Children Deprived of Liberty

Summary

This article defines the concept of ‘institution’ as “any residential setting where children and young people“, whether ‘social’ orphans or truly lacking biological family, “are subjected to… depersonalization, rigidity of routine, lack of individual support or personal treatment,….consistency,permanency and continuity…. excluded from the wider community, with limited contact with birth families or care givers….”  They may be subjected to physical and psychological harm, leading to physical and intellectual delay.

The article also points out the dangers of “voluntourism” and the “orphanage economy” when people hoping to help are actually encouraging a source of revenue and make orphanages as a way of life for a child appear very viable, covering for the many ways it has a destructive impact on a child.

The Impact of Early Orphanage Life on Development   

Lisa Nalven, M.D., FAAP 20 Apr 2017

Summary

Again referencing the possibility of issues resulting from a difficult family start and the  deprivation of a childhood in institutional care, particularly in the first 3  years of life, resulting in developmental delay and disease,  the article looks at the outcomes post-adoption.

Some children “catch-up” while others, those with longer stays, “[s]pecifically, the children who had spent more than two years in an orphanage sustained a range of intellectual deficits …” and other deficits.

THE EFFECTS OF EARLY SOCIAL-EMOTIONAL AND RELATIONSHIP EXPERIENCE ON THE DEVELOPMENT OF YOUNG ORPHANAGE CHILDREN   

The St. Petersburg—USA Orphanage Research Team  Monogr Soc Res Child Dev

Summary

Based on an study of St. Petersburg orphanages, the focus was the impact of the limited care-giver to child interactions for reasons mentioned in articles above.  When these children were offered improved care-giver to child interactions the children evidenced improved physical, mental, and social-emotional development.

For example, ….[A]lthough some orphanage children are malnourished, nutrition does not seem to be the primary factor in the children’s short stature. Orphanage children are often observed to eat substantial amounts of food, and their weight is consistently higher than their height, especially the weight/height index, suggesting to some investigators that psychosocial deprivation is a major cause.

Like articles above, this article notes age and time in care but also notes that many problems do recede post-adoption. The problems that are more stubborn have to do with “executive functioning, including rigidity in thinking; inability to generalize solutions to specific problems; poor logical and sequential reasoning; excessive concreteness of thought; poor concentration, attention regulation, and inhibitory control; and restlessness and fidgeting“.    Other problems with behaviour, relationships, and attachment may continue. The article then makes this hopeful statement: “Curiously, the majority of adopted orphanage children develop typically”.

The article concludes by stating: The interventions focused on the caregiver–child social–emotional-relationship and warm, sensitive, responsive caregiving, and children’s development improved substantially in every major measured domain with no corresponding changes in medical care, nutrition, safety, sanitation, and abuse. Thus, it appears that the social–emotional-relationship environment is at least a—if not the—key contributor to improving children’s development in the orphanage.

Structural characteristics of the institutional environment for young children

Psychology In Russia Developmental psychology  Volume #9, 3, 2016  DOI: 10.11621/pir.2016.0307

Another article regarding the study of two St. Petersburg orphanages.

A Descriptive Study on Behavioral and Emotional Problems in Orphans and Other Vulnerable Children Staying in Institutional Homes   Post-Orphanage Behavior In Internationally Adopted Children  

Boris Gindis, Ph.D.    April 2012

Summary

This article repeats much of the material of the above articles but does so as a definition of Post-Orphanage Behavior or POB syndrome: “a cluster of learned (acquired) behaviors that could have been adaptive and effective in orphanages but became maladaptive and counter-productive in the new family environment”.  These behaviours include: poor self regulation, mixed maturity, self-parenting, learned helplessness, controlling and avoiding behaviour, self-soothing and self-stimulating behaviour, hyper-vigilance and “pro-active” aggressiveness, feelings of entitlement, extreme attention seeking, and indiscriminate friendliness with strangers.

Boris Gindis offers thoughts for helping the adoptee now in a family setting and ends with the following:

The question is, how long do you need to wait for POB to subside before you know “something is still not right, there is a problem”? I have no answer for all individual situations, but the rule of thumb is this: POB has a tendency to recede with time (several months to a year or longer in some cases), while a genuine disorder will stay and get worse. The bottom line is that POB is a “learned” behavior: a set of survival skills that are functional and adaptive in the specific milieu of an orphanage. Therefore, the only remedy is to substitute these orphanage skills with newly learned, different, and at times opposite behavior.

CBCL Behavior Problems of Post-Institutionalized International Adoptees

Clin Child Fam Psychol Rev. Clin Child Fam Psychol Rev. 2010 Jun; 13(2): 199–211.  doi:  10.1007/s10567-010-0068-x

Summary

This article reviews 18 studies, each of which used the Child Behavior Checklist. The conclusions highlight the major issues for post-institutionalized (PI) children brought forward in the above articles, seeing the age at adoption as most concerning.    They conclude with an interesting, and I think,  important statement: “While the majority of PI children are within the normal range of behaviors, both the popular press and research studies reveal higher than expected rates of behavior problems, some quite severe, in a minority of the PI population, suggesting a probabilistic rather than deterministic influence of early deprivation”.

The article brings up two points not noted in above articles: (1) children often spend time in hospital care before being sent to an orphanage that  usually only has time for taking care of the body, with no time for the emotional needs. The same is true for children needing hospital care while residing in an orphanage. (2) Children who are as Bruce Perry notes, cute or favourites of care-givers may receive, not only better physical care, but also better social and emotional care.

THE “GILDED CAGE” OF THE DOM REBYONKA: INFANCY TO FOUR YEARS

https://www.hrw.org/legacy/reports98/russia2/Russ98d-05.htm

Summary

“You’ll see a child lying on a cot staring at the ceiling, obviously in terrible need of love—I have heard the staff say in all innocence to me, “We told the mother ‘don’t bother to come to visit.’ The child doesn’t understand anyway.”

This article moves from the abstract and academic to the graphic reality of life in Russian orphanages in the ’90s.  I do not know if it has current applications but it does find that children of children held in orphanages are subsequently abandoned to the orphanages because the parents raised in orphanages have little idea how to parent in a family setting.

The “gilded cage” image comes from the reality that though orphanages, particularly for orphans from one to four, get international charity, the money does not actually change the lives of these children. The children continue to be denied personal possessions, even a personal teddy bear. It details the conditions of “lying-down” rooms, analysis of the actual meaning of diagnoses given,  the use of sedative drugs, denial of corrective surgery, and the lack of sufficient training and salary for staff.

It does also note that Human Rights Watch had come across several orphanages which had implemented the “cottage approach” offering better care.

International Adoption 

Mary Allen Staat, Simone Wien, Emily Jentes https://www.cdc.gov/centers for disease control and prevention Chapter 7 Family Travel National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Division of Global Migration and Quarantine (DGMQ)  Travelers Health

Summary

This site provides a list of vaccines for potential adoptors and siblings of the potential adoptee, as well as, the vaccinations needed for the adoptee.

5 Compelling Reasons not to put Kids in Orphanages

https://www.craiggreenfield.com/blog/orphanages

Whenever there is a natural disaster, like the earthquake in Nepal, there will be some well-meaning but poorly informed outsiders who decide to build an orphanage.

The short and simple response is: “These children have lost their parents, why take them away from everyone else they know and love as well?”

Summary

With problems like limited staff, the cost of keeping a child in an orphanage which this article says is “about twelve times the cost of support in a community-based care program” and the need to seek resources outside the country because the article says that “virtually all orphanages are now located in the developing world“,  orphanages are not the best way to care for orphans. The article, on the other hand, presents the better option of community care, undertaken by the community itself and maintaining a sense of connectedness for the child, as well as, perhaps less abuse, stigma and more opportunity to develop needed life skills.

A Descriptive Study on Behavioral and Emotional Problems in Orphans and Other Vulnerable Children Staying in Institutional Homes

Indian J Psychol Med. 2018 Mar-Apr; 40(2): 161–168. doi: 10.4103/IJPSYM.IJPSYM_316_17

Summary

Repeating all that is said in above articles focusing on Russian and Romania, this article finds the same can be said from a study looking at orphanages in Karachi, Pakistan.

Orphans’ Lonely Beginnings Reveal How Parents Shape A Child’s Brain

https://www.npr.org/progrm/morning-edition/2014/02/24/281916671

Summary

Adopted from a Romanian orphanage, Izidor Ruckel, has written about his life in the orphanage and later as an American adoptee. This article parallels what is known about parenting and the lack of parenting  alongside this man’s experience, showing how it impacts brain development and wiring.  Ruckel speaks of his abusive behaviour toward other children because he knew no better way to survive.

The Romanian orphans “odd behaviours, delayed language and a range of other symptoms suggested problems with brain development” which EEGs revealed as “low levels of brain activity” and MRIs showed reduced gray and white matter in their brains. The children’s “brains were actually physically smaller“.

The scientists realized the cause “wasn’t anything as simple as malnutrition. It was a different kind of deprivation – the lack of a parent, or someone who acted like a parent“.  For example, if all that a child is experiencing is staring at the ceiling of the room without anyone offering care, “areas of the brain involved in vision and language and emotion don’t get wired correctly“.

Once adopted Ruckel began to have problems relating to the people around him as caring family.  He understood relationships to be about abuse. When his parents showed him kindness, it made him angry.

Scientists see that as “abnormal circuitry in the brain involved in parental bonding….the amygdala signal [is] not discriminating Mom from strangers“.   As an adult Ruckel reunited with his parents for as he says, “I believe that even the brain cells that don’t work as a child, I believe that they can develop as a grown man“.  Scientists refer to it as the brain’s ability to rewire.

Family matters: A study of institutional childcare in Central and Eastern Europe and the former Soviet Union

Email: gen@everychild.org.uk Website: www.everychild.org.uk     Carter, Richard (2005) : London: EveryChild. Copyright © 2005 EveryChild iii

Summary

This report from 2005 brings attention to the lack of change in the care of children since the Romanian orphanage exposure, reminding the reader that more often than not the children are ‘social orphans’, warning that the numbers are under reported and that these damaged children will likely become damaged adults.

A history of the development and use of Russia’s orphanages is outlined.  But, I think, the primary objective of the article is to draw attention to the misleading idea that poverty is the baseline explanation when in fact ideas of the role of state in family affairs and social/economic breakdown of society must not be ignored.  To support this the writer looks to William Goldfarb and John Bowlby’s research on the “effects of early parental deprivation” to counter the idea that the state will ever do a better job of parenting than the family.

The article joins the many articles above itemizing the conditions and effects of institutional child care: poor health, physical underdevelopment, hearing and vision problems, motor skill delays, reduced cognitive and social ability, and  abuse, but does not spare the reader the horrifying detail. I am watching Bones of Crows and this article reminds the reader that the problems are not only an Eastern European shame. “In Canada, there were horrifying reports in 1989 of both physical and sexual abuse of young boys at the Mount Cashel Orphanage run by the Christian Brothers; neither the child protection services nor the police proved effective in preventing this abuse“.

This is one paragraph in the Preamble to the UN Convention on the Rights of the Child which is agreed to by many of these states  and “sets out a very clear statement of principle on how children should be able to grow up: Recognizing that the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding”.

The conclusion: “Institutions are almost always harmful for children’s development.  Family-based care is both better for children than institutional care and significantly cheaper for the state”.

Protective Influences of Families for Children Adopted From the Former Soviet Union

McGuinness, Teena MRyan, RebeccaCheryl Broadus Robinson.  Journal of Nursing Scholarship; Indianapolis Vol. 37, Iss. 3,  (Third Quarter 2005): 216-21. DOI:10.1111/j.1547-5069.2005.00038.x

If you have access to this site: its purpose was to “characterize the total competence of 9- to 12-year old children adopted from the former Soviet Union who have resided in the United States at least 5 years, and (b) evaluate risks and protective influences of adoptive families and their relationships to competence“.  The conclusion was that “Families continued to face challenges, but findings were consistent with other studies showing that, despite early adversities, these adopted children generally fared well developmentally with protective family environments of major importance”.

Perception of oral health and practices among children residing in orphanages in Bengaluru
Thara Chandran
Department of Public Health Dentistry, AB Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India Date: 27-Dec-2021 DOI: 10.4103/jpbs.jpbs_751_21
Summary

Due to financial constraints, oral health problems of children in orphanages are not given due attention.

Behavioral problems among children living in orphanage facilities of Karachi, Pakistan: comparison of children in an SOS Village with those in conventional orphanages

Social Psychiatry and Psychiatric Epidemiology; Heidelberg Vol. 46, Iss. 8,  (Aug 2011): 787-96. DOI:10.1007/s00127-010-0248-5

Summary

SOS and orphanages are compared. “SOS is an international movement that aims to provide housing and care to orphaned children. It was started in Imst, Austria, in 1949 after World War II by Herman Gmeiner. Gmeiner believed that all children needed a mother, a home, siblings and a family”.

Because of the bio-psycho-social difficulties that orphans deal with, SOS, while a model for child care over orphanages,  will not be a problem -free option, especially if the foster mother is not mentally healthy and the homes available cannot meet all of the child’s nourishment needs, leading to the conclusion that mental health intervention should be made available for both the foster mother and the child to be taken in.

Orphanages are no place for children: Orphanages are dangerous and inhumane.

Ahern, Laurie.  The Washington Post (Online), Washington, D.C.: WP Company LLC d/b/a The Washington Post. 2013.

Summary

The article makes the point that building and/or maintaining orphanages via  government support or charities/voluntourism does not benefit the children. Rather it has become a business opportunity that can lead to even more desperate situations for the children.  To take that same support and invest it in supporting the child within a family, especially if the child,  as in most cases, does have family. The article states that investing in families is less expensive.

Orphanages damage children for life, says group founder: Negative attitude towards disabled, orphaned or adopted youngsters has to change, says author

Ngo, Jennifer.  South China Morning Post; Hong Kong [Hong Kong]. 27 Nov 2014: C.1.

This article now requests subscription for access.

Summary

The article highlights the book, Waiting for a Father: hearing the heart-cry of the orphans of the world, which speaks to the cultural attitudes toward orphaned or adopted children, particularly if they are disabled. The writer of the book, Gary Stephens, is quoted: “Not being willing to accept children with special needs or adopted children is a cultural blemish, not a cultural bias – it is something that is bad in a culture and needs to be changed,…. We need to take the children out of institutions and into foster families – ultimately to a permanent family,” he said. “A child never should wait for a family, a family waits for a child.”

Emotional and Behavioral Problems of Children in Orphanages of Khyber Pakhtunkhwa

Alam, AmirImran Ahmad Sajid.  Journal of Behavioural Sciences; Lahore Vol. 32, Iss. 2,  (2022): 81.   Mahanta et al. BMC Pediatrics (2022) 22:722  https://doi.org/10.1186/s12887-022-03785-2

Summary

The study of orphanages in Pakistan noted that the majority of the orphans were “paternal orphans. This indicated that the death of the father is the major cause of placing orphans in orphanages.  An interesting observation of this article is the positive attitude of Pakistanis to their responsibility for the vulnerable, but based on the John Bowlby’s theory that detachment from the emotional bond between a child and the parents will lead to a variety of struggles for the child, no institution can adequately meet the void left.

A further thought states that the  “three basic human needs are existence needs, relatedness needs, and growth needs“.  These three are entwined to the extent that if one is denied, the child will struggle with the development of the other two.  “Behavioral problems often start in early life and can affect children of all ages. Nonetheless, the results of the current study reveal that a significant majority i.e. (n=124, 65.3 %) of the orphans were having good behavior and thus they had no behavioral problems. There are many reasons for the good behavior of these orphans. Firstly, the basic needs of the inmates were satisfied. Secondly, the caregivers were taking good care of the inmates“.

But it is the third reason, one I have not come across before, that is worthy of simply being quoted: “...A significant majority i.e. 69.5% of the orphans were from the age group of 11-16 which indicates that children at this age have the least chances to have behavioral problems as compared to children below 6 years as this is a life stage during which very rapid and different changes occur in human brain and mind….the mental health status of the orphans is exacerbated the most when they are too young and the duration of institutionalization is too long as the growth of the brain and the emotional regularity is higher in the early years of the childhood”.

Magnitude and Associated Factors of Undernutrition Among Children Aged 6–59 Months in Ethiopian Orphanage Centres

Teferi, HaimanotTesfalem Teshome.  Pediatric Health, Medicine and Therapeutics; Macclesfield Vol. 12,  (2021): 141-150. DOI:10.2147/PHMT.S28980

Summary

At the time of this study Ethiopia had among the highest number orphans in the world. The study looks at the issue of under-nutrition in Ethiopian orphanages. The damage done because of a lack of nutrition, not having been breastfed, vaccinated or being given basic hygiene has already been shown via studies of Romanian orphanages.

Is left-behind a real reason for children’s social cognition deficit? An fNIRS study on the effect of social interaction on left-behind preschooler’s prefrontal activation

Ding, KeyaLi, ChuanjiangJia, HuibinZhang, MingmingYu, Dongchuan.  PLoS One; San Francisco Vol. 16, Iss. 9,  (Sep 2021): e0254010. DOI:10.1371/journal.pone.0254010 E-mail: dcyu@seu.edu.cn

Summary

This study examined the social cognition deficits in children when parents leave them in care with family or friends while they move to another location for employment, referring to this as “the left-behind phenomenon“.  “Social behavior is highly dependent on which people interact and their relationships with each other“.  The study ends with the suggestion that a better way might be for one parent to stay with the children while the other leaves for employment.

The Emotional experiences of children living in orphanages in Ghana
This article requires access and explores the emotional experiences of orphans in orphanages in Ghana.

Upreti, RashmiSharma, Seema.  Indian Journal of Positive Psychology; Hisar Vol. 12, Iss. 2,  (Jun 2021): 118-121.

Summary

The self-esteem of adolescents from orphanages, single parent families and intact families were compared.  It was concluded that the self-esteem of adolescents could be boosted up by the care and support of the parents/care-givers“.  A definition of self-esteem offered:self-esteem is an evaluation that an individual makes of himself or whatever feelings he holds about himself…. considering “gender, ethnicity, and social class.  The study came about from concern for the negative impact and subsequent negative expressions of low self-esteem with the reminder that self-esteem in best developed through supportive parents.

The Nutritional Status of Individuals Adopted Internationally as Children: A Systematic Review

2021 Jan; 13(1): 245. Published online 2021 Jan 16. doi: 10.3390/nu13010245

This article is dated 2021, a short 3 years before I am summarizing it.

‘”…. Globally, there are some 140 million children worldwide who are orphans, defined as those aged younger than 18 who have lost “one or both parents to any cause of death”. There are also an estimated 60 million children living on the streets worldwide and 10 million more living in institutions, which is defined by the United Nations as residential care that is provided in any non-family-based group setting’“.

The article is reviewing studies having to do with the long term health of adoptees who have been undernourished, with iron, zinc and vitamin D deficiencies but increased cortisol levels particularly addressed.  “Early menarche may also increase a person’s risk of metabolic syndromes such as adulthood obesity, cardiovascular disease and diabetes“.  Reviewed are pre-adoption, peri-adoption and post-adoption factors, noting that catch-up is possible in weight, height and head circumference, though there was a “significant inverse association between age of adoption and head circumference catch up“.

Child maltreatment, attachment and psychopathology: A case report M.D.C.

Molina Lietor*, I. Cuevas and M. Blanco Prieto Psiquiatría, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain     doi: 10.1192/j.eurpsy.2021.1666

Summary

This article is a case report of a 17 year old male from Spain who was subjected to severe maltreatment from his “family of origin” leading to an diagnosis of RAD. The case report is showing the trajectory of maltreatment to RAD among adoptees.

Depression Screening in Orphaned Children: A Systematic Review

International Journal of Caring Sciences; Nicosia Vol. 14, Iss. 2,  (May-Aug 2021): 1409-1418.

This is a particularly useful article for adoptors as it deals with the depression of children who have started life in an  orphanage.

Summary

“The main characteristics of depression is the persistent feeling of sadness, irritability and lack of interest or satisfaction from any activity”.  Children will express depression in manners across a wide spectrum ranging from sadness to shame, hyper activity to tamped down mood, lack of interest in food, disrupted sleep, illnesses, lack of concentration, and difficulty with social and academic situations, especially if they are too young to be able to handle language well enough to express their sadness. One particular struggle has to do with dealing with the death of their parent/parents, particularly the mother, because they cannot believe that their beloved person will not be around again. The way children understand the death is basically a developmental process, from which it depends to a large extent how their mourning will be expressed“.  This lack of understanding can encompass and lead to a fear that any one they love might die.

“Children must be clearly and honestly informed about the death they are or will be facing. They need to prepare and manage their bereavement, just like adults. Sometimes, they need to say goodbye to their parent’s death and this must be encouraged, as long as that the caregiver will be able to be sensitive and capable of responding with love to them”.

Orphanage Risks Factors are still a concern and are still being written about

Risk and protective factors for mental health and wellbeing among adolescent orphans

ORCID IconRonald E. Dahl  Samantha Bertomen Emily Hipp Priyanka Shreedar Prosper F. Njau

Health Psychology and Behavioral Medicine An open access journal Volume 11, 2023 – Issue 1
Risk factors of orphan and vulnerable children in a children’s home during the COVID-19 pandemic

Children and Youth Services Review  Volume 145, February 2023, 1068  Lucia Munongia,

145: 106801. Published online 2022 Dec 30. doi: 10.1016/j.childyouth.2022.106801  PMCID: PMC9803368
Think Differently

Orphan Risks  https://riskinnovation.org/think-differently/orphan-risks/

What are the challenges faced by orphans?
https://typeset.io/questions/what-are-the-challenges-faced-by-orphans-ql8km1d5ge
The Vulnerabilities of Orphaned Children Participating in Research: A Critical Review and Factors for Consideration for Participation in Biomedical and Behavioral Research
Published in final edited form as:

doi: 10.1525/jer.2012.7.4.56 PMCID: PMC4288965 NIHMSID: NIHMS457875 PMID: 23086048

Definitely Check out this Address:

https://www.wearelumos.org/