Institutionalization
and its effects on childhood brain development and social skills
22,000 infants and children adopted into the U.S. each year.
8 million children, 0-8 years old, in orphanages, most in Eastern
Europe and Asia.
Institutionalization can be considered an Adverse Childhood
Experience.
Studies show that institutionalization affects brain development.
Dose-response relationship: longer stays in orphanages put
children at higher risks for behavioral disorders.
Effects: social, behavioral, cognitive, neuro-physiological Institutionalized Rearing
versus Maternal Care
Maternal care in first year of life sets the model for behavior
and stress management for the rest of life.
Conditions may range from poor to very harmful.
Inconsistent peer groups
Lack of play time
Inadequate food and clothing
Low emotional tones
Lack of sensitive nurturing
Lack of emotional stimulation
Constant detachment
Inattention to individual needs
1:20 caregiver to child ratio
Few interactions with caregivers
60-100 different caregivers within first 2 years Brain Development ACE Cycle
Absent, inadequate
or incorrect expected
environment
conditions
More ACE’s
More stress
Greater
emotional reactivity
Larger amygdala
Damaged frontal cortex
Smaller brain volume
Smaller corpus callosum Possible Development
Delayed psychomotor and speech development
Quasi-autistic
Attention-Deficit/Hyperactivity Disorder (ADHD)
20.7% of PI to 3.4% of NI
Lower IQ
Impulsivity
Poor emotional expression and recognition
Difficulty being empathetic and sympathetic
Indiscriminate/Disinhibited Reactive Attachment Disorder
Lack of social model for behavior
Indiscriminate sociability
Attachment to unfamiliar adults
Willingness to leave with unfamiliar adults Adolescent Behaviors
Attention-seeking mechanisms may be triggered as survival
mechanisms for orphans accustomed to neglect.
Difficulty in recognizing affection or care from adoptive parents
Hesitancy to trust and to ask for help
Insecurity about being abandoned again
Not coming home
Not going to school
Alcohol and substance abuse
Indiscriminate socialization, especially with others who are bad
influences
Difficulty handling stress
Heightened perception of threats and negative emotions Research
How institutionalized children perceive negativity
Emotional Go-No Go Paradigm
Compared to NI, PI children
institutionalized for longer (more
than 15 months) made more errors
identifying neutral faces when
distracted by negative faces.
Institutionalized children are more
reactive to negative emotions. Research
Studies
Author of Paper
Study Referenced
Felicia Iftene (2004)
Children
Age at Testing
34 PI
13-16 yrs
Mitul Mehta (2009)
The English and
Romanian Adoptees Study
14 PI
ȳ=16.2 yrs
11 NI
(England)
ȳ=16.0 yrs
136 PI
6-30 mo
Margaret Sheridan
(2010)
Bucharest Early
Intervention Project
Nim Tottenham
(2010)
72 NI
Age-matched
(Romania)
38 PI
ȳ=101mo
40 NI (U.S.) Age-matched
Time in
Orphanage Adoption
Institution Location
Location
6-36 mo
Romania
Canada
(1980s)
Romania
ȳ=24.7 mo Romania
England
(1980s)
6 mo-8 yrs
Romania
Foster
Care in
Romania
9-28 mo
E. Europe,
Asia
U.S. Neuroplasticity
Earlier adoption linearly associated with better development.
PI adopted before 6 months old repaired their cognitive
development faster than PI adopted after 6 months old.
PI adopted before 15 months old more likely
to reach the same development rate as NI.
PI relocated to foster care before
24 months old had greater
development catch-up than PI
relocated after 24 months old.
By 6 years old, PI adopted
before 6 months old had
same IQ’s as NI while PI
adopted after 6 months old
still had the lowest scores.
Institutionalization and Its Effects on Childhood Brain Development and Social Skills
of 9
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