Emma Gore Langton, winner of the undergraduate category of our student writer competition, on the mutually beneficial relationship between psychology and children abandoned in institutions.
18 July 2006
Romania’s children caught the eyes of the world when communism fell in 1990; perhaps you remember the images? The state had strictly controlled all fertility-regulation methods, and the majority of citizens were living in considerable poverty. Against this background, many women gave birth to children they were unable to care for, and attempted abortions meant that high numbers of children were born with special needs. Such children, as well as many with no evident problems, were abandoned to the care of the state.
Children were packed into institutions where segregation by age group and by perceived ability/handicap resulted in very limited contact with older and more able peers. Following ‘assessment’ at three years, children and young people labelled ‘irrecuperable’ were allocated no resources.
They were kept out of sight in very large ‘neuropsychiatric’ institutions, where food, clothing and heating were insufficient. They also experienced far-reaching sensory deprivation, with minimal interaction with adults. Visiting journalists commented on the absence of sounds of laughter or play. Routines were inflexible and did not accommodate individual needs, and there were no educational opportunities.
The effects of such deprivation are well reflected in the health of Romanian children adopted into the United States, with increased incidence of illnesses such as TB and intestinal parasites, and abnormally low length, weight and weight for height. Only 15 per cent of these children were judged to be healthy and developmentally normal (Johnson et al., 1992).
These were certainly not the first children to grow up in poverty or be institutionalised. Indeed, the ill effects of institutional care had already been well documented (e.g. Bowlby, 1973). Yet the children who passed through these institutions have been the objects of keen interest. Prior to their discovery, psychological research into questions of deprivation had been largely limited to a few individual cases, such as that of ‘Genie’ (e.g. Curtiss, 1977), and a few sibling sets (e.g. Skuse, 1984), occasionally encompassed individual institutions or organisations, such as the Crèche in Lebanon (Dennis, 1973).
The sheer numbers of Romanian children, the extent of the deprivation, and the slow pace at which change has taken place were unprecedented. Their early experiences, which cannot ethically be inflicted on people, offer us information about a wealth of questions fundamental to developmental psychology. They provide a perspective on many aspects of the nature/nurture debate, such as the extent of environmental input required for normal development, and whether developmental disorders such as autism can be caused by deprivation.
Studies of children who remain in institutions show that their development is delayed across the board, displaying very poor cognitive, emotional, behavioural and language skills (Kaler & Freeman, 1994). Some children showed quasi-autistic symptoms (Rutter et al., 1999), but after adoption these symptoms progressively lessened and cannot be considered true autism.
Children removed into enriched environments have shown us whether developmental catch-up is possible following deprivation, and whether critical periods might exist for such catch-up. Of particular interest have been the children adopted into the UK from Romanian institutions ; their progress has been followed by Professor Michael Rutter and the English and Romanian Adoptees study team.
Evidence from this group is more positive: at four years old, Romanian adoptees showed great physical and cognitive improvements (Rutter et al., 1998). In fact, those children adopted before they were six months old were faring just as well as children adopted within the UK. Children adopted after the age of six months were also much improved, but lagged behind the other two groups. On follow-up at six years, these improvements were maintained, but not advanced upon (O’Connor et al., 2000). Similar findings were reported for children adopted into Canadian homes (Morison et al., 1995; Morison & Ellwood, 2000).
A significant minority of the adopted children still experience severe difficulties, which may be linked with the duration of institutionalisation. The most enduring finding has been attachment difficulties, with many children displaying ‘indiscriminate friendliness’ (Chisholm et al., 1995; O’Connor et al., 1999).
Overall, the findings suggest that deprivation, limited to the first six months of life, is not devastating for a child’s development. However, when deprivation continues it has a more severe and longer-lasting impact. In any case, removal to an enriched environment such as an adoptive home significantly improves the outlook for all children, though improvements do not continue indefinitely.
Time to serve the children
Romania’s children have long since vanished from our television screens, yet the care of children living away from home is an ongoing concern for Romania. At the end of August 2004 the Romanian National Authority for Child Protection reported a total of 81,233 children in care, of whom 32,053 were in institutions.
While a recent move has been made to close down large state institutions, large numbers of children are still cared for together. NGOs and some child protection departments have established foster care programmes, while other children live in smaller ‘family-style’ homes. In-country adoption is rare because of widespread poverty and no provision for easing the financial burden on adoptive parents, and international adoption was eventually permanently banned in 2005 following allegations of widespread corruption and baby trading.
Given this development, studies of children adopted internationally are of limited help to the children currently in the system. These children have served the field of psychology well. It is now our turn to serve them. The question now must be: how can the Romanian care system be organised so as to maximise benefits to the children who remain within it, and to those who will enter it? Much of the groundwork has already been done, but must still be applied to the particular socio-economic climate of Romania.
Given that institutions do exist, how can the lives of children within them be enriched? A range of studies in UK, US and Russian institutions have identified key factors in institutional care, and there has already been some success transferring these principles to a Romanian institution. Sparling et al. (2005) experimentally introduced stable adult–child relationships, small group size, enriched caregiving and educational activities to a Romanian orphanage, and concluded that such interventions are universally beneficial.
In the UK it has long been considered that children in foster care fare better than those in group institutional care. Roy et al. (2004), for example, found in a UK sample that institutional care, but not foster care, disposed children to a lack of selectivity in social relationships. It remains to be seen whether these findings transfer to foster care in Romania.
We must also look more closely at the causes of ongoing high levels of abandonment, and how these can be tackled. It seems imperative that greater support is offered to families who wish to care for their children in the face of great adversity.
All of the above concerns how to improve the lives of children in a fairly direct way. Yet much work is to be done indirectly. Perhaps the most immediate question about the initial conditions of these children is: how did this come to happen? Little research has been done concerning the people who worked in such institutions. Certainly, they were working in very constrained circumstances, with no resources and unmanageable high numbers of children. There may be issues of obedience to authority, hardening to suffering, motivation and fundamental attitudes.
Romania’s children are cheerful, charming and resilient. The next few years are a particularly critical period in the history of Romanian child care, as it comes under great pressure from the EU to change its entire structure. It is essential that the knowledge that we have gained from the study of these children is now used to influence structural changes, and to monitor the outcome of such changes.
Emma Gore Langton is an undergraduate at the Department of Experimental Psychology, University of Oxford. E-mail: [email protected].
ERA study team at the Institute of Psychiatry: tinyurl.com/ka4ksRomania Information Centre in Brussels: http://crib.mae.ro