No Orphanage is a Good Orphanage

Kids suffer long-term developmental problems, study says

SATURDAY, Feb. 22, 2003 (HealthDayNews) -- Even after being adopted into loving homes, children who have spent time in orphanages can suffer from a number of continuing developmental problems.

These can range from elevated levels of the stress hormone cortisol to changes in the central nervous system to difficulty with attention.

A group of studies just presented at the American Association for the Advancement of Sciences' annual meeting in Denver all seem to have the same message: There's no such thing as a good orphanage.

One study found that children in institutions lagged behind others on virtually every measure of development.

"It appears that the longer kids spends in an institution, the harder it is to go back," says Charles Nelson, lead author of the study and a professor of child psychology, pediatrics and neuroscience at the University of Minnesota in Minneapolis.

Many early problems will disappear with time, Nelson says, but there are two that often persist: difficulties with interrelationships and with executive function, which includes memory and attention.

Nelson and his team have been following three groups of children in Bucharest, Romania. The first live in orphanages, the second spent some time in orphanages before being assigned to foster care, and the third live with their biological families.

The children who have spent all of their lives in orphanages were behind both other groups of children on measures of cognition, language abilities, behavioral adjustment and neurophysiological indicators.

"Across the board, we're finding institutionalization is having pretty negative effects with not a whole lot of time in foster care," Nelson says. Sometimes damage is done in as little as three months, though it's usually more than that, he adds.

The kids in foster homes are acting as a sort of living experiment, enabling the researchers to determine "how long will it take us to get the kid back on a normal trajectory given they've been institutionalized," Nelson says.

No one is sure exactly why the differences in development are occurring.

"We think deprivation is occurring on a pretty broad scale, and it's hard to know exactly," Nelson says. "Is it separation from the maternal caregiver? Is it lack of intellectual or perceptual stimulation? Everything is on the table for discussion."

Levels of deprivation do vary, at least among the orphanages Nelson is involved with in Romania, he says.

Some ward rooms are painted in bright colors with decorations on the cribs. Others are awash in white. However, the kids' care is the most striking: some are even put in cages and not given a chance to walk, Nelson says.

"There's the truly awful orphanage, and then there is the less awful orphanage," he says. "What they all have in common is deprivation."

The Romanian foster homes are a completely different story. Taking care of a child is considered to be full-time work and caregivers are prohibited from holding jobs, which lets them devote their time and energy to the children.

The maximum number of children allowed in one house is two. All the foster parents receive extensive training and get material support including clothes, diapers and toys for the kids, Nelson says. The children also have access to 24-hour medical care.

It's unclear if this model would work in the United States, where foster care operates differently and also varies from state to state.

"If I had to choose [between] foster care generically and an institution, no question I would choose foster care," Nelson says. "There is bad foster care, but there is probably no such thing as a good institution."

More information

For more on adoption, visit the National Adoption Information Clearinghouse.

For more on child development, visit the National Institute of Child and Human Development

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