Study on orphans sees benefit in family care
⬤
public
Study on orphans sees benefit in family care
By Colin Nickerson, Globe Staff | November 11, 2006
BUCHAREST -- Four-and-a-half years ago, Mimi was among the thousands of infants languishing in Romanian orphanages. A listless, joyless girl, she lacked the sparkle that draws sympathy -- and special attention -- even in a state facility. No overworked caregiver was going to waste time waggling fingers or making coo-coo sounds to blank-faced Mimi, abandoned at birth by her own mother.
Then she got lucky.
At the age of 18 months, Mimi was plucked from St. Ecaterina orphanage in Bucharest and entrusted to foster parents as part of a small but ambitious MacArthur Foundation-financed study of the effects of family rearing on formerly institutionalized children -- research that has spawned surprising controversy in Europe and beyond.
The ongoing study strongly suggests that raising an abandoned child in a family setting is not just socially desirable but medically therapeutic to the child . Orphans given over to family care at a very early age -- ideally before age 2 -- are almost certain to grow up stronger, healthier, and smarter than those who remain in institutions.
Even more dramatically, the study has found that foster care -- or better still, adoption -- appears to actually undo some of the developmental harm done to children in state facilities. But the speed of placement, getting a child into a family before too much institutional damage is done, may be at least as critical as the quality of the new home.
"In almost every case, the sooner an orphan is placed with a family, the better off that child will be," said Charles A. Nelson, professor of pediatrics at Harvard Medical School and one of the lead researchers on the Bucharest Early Intervention Project.
The project comes at a time when "international adoptions" (almost entirely by Americans) have become a hot-button topic in Europe, Africa, and Asia. Not since the Vietnam War has the United States been so generally mistrusted abroad, mainly because of the Iraq war and Washington's perceived arrogance.
Romania -- even with 30,000 orphans in state facilities and infants abandoned at a rate of 20 a day -- has nonetheless slapped a moratorium on adoptions by all foreigners, a move that seems at least partly intended to stop the flow of infants to American families.
Mimi, the orphanage girl, is among the more fortunate abandoned children -- she has found a permanent family in her native land.
In 2001, when she was entrusted to foster mother Illeana Udeanu as part of the Bucharest study, Mimi was chronically ill, pathetically undersized -- unable to feed herself, unable to totter, and unable to talk.
"Her lips never smiled, her eyes seemed empty," said Udeanu, who recently adopted the girl.
Compared with the infamous orphanages of Romania's communist era, the facility where Mimi spent her first 18 months of life was neither cruel nor neglectful. Diapers were changed. Nutrition was adequate. Babies had blankets.
But children failed to thrive, almost shriveling in size and intellect with the passage of days, weeks, and months.
Based on the study, which started in 2001 and is scheduled to continue through the end of the decade, Nelson and his fellow researchers are convinced that prolonged stays in even fairly well-run orphanages do extraordinary damage to the minds and bodies of children , especially if the institutionalization occurs during critical months of early development.
"A child placed in foster or adoptive care before the age of 24 months is going to have a higher IQ, a stronger body, and an all-around better chance in life than a child who stays longer in an institution," said Nelson, who also directs the lab for cognitive neuroscience at Children's Hospital in Boston. The other lead researchers on the project are Charles H. Zeanah of Louisiana's Tulane University and Nathan A. Fox of the University of Maryland.
Mimi, now 6 years old, is one of 69 Romanian orphans placed in family care for the study. Their development was tracked against that of 67 children remaining in orphanages and a control group of 72 children in ordinary Romanian families.
The children, then aged six months to 31 months, were tested at the outset of the project and then again roughly every year. Each battery of tests included measurements of head and body size, as well as tests of intelligence, emotional health, response to stimuli, and brain wave activity.
Since she was placed with the Udeanu family, which includes two older sons, Mimi's IQ has risen into normal range. Her size and weight are slightly below average for her age, but she's grown faster than orphans in the institutionalized group. She's still a somber child, but can flash a winning grin.
"What I like most is coloring books with cats and parrots," she told a reporter visiting her family. "Also, elephants and turtles."
Said Udeanu: "She's just an ordinary girl. But ordinary is a miracle, in her case."
One finding of the study: At a base line of 20 months of age, children in orphanages scored 72.5 in "development quotient" -- IQ, basically -- on the Bayley scale, while children newly in foster care scored 76.1. At age 42 months, the score of children who had been taken in by foster families rose to 86.3 points, while the score for institutionalized children had risen only to 77.1, a significant difference. Children in regular families scored over 100 both at the baseline and beyond.
On other fronts, institutionalized children are more than twice as likely to show symptoms of depression or anxiety as orphans in foster care or adoptive homes.
Occasionally, Nelson said in an interview during a recent research trip to Romania, the poor performance of institutionalized children reflects genetic abnormalities or medical conditions unrelated to the institutionalized life.
But more often, he said, the dismal development of orphan children simply reflects being raised in a facility. The brain seems to "rewire" itself wrongly when deprived of the close personal attachments within a family. The institutional setting itself, with its stressful environment and reduced levels of human interactions, seem to cause declines in growth hormones and other stimulants to healthy development.
"Sure, it sounds intuitive, that kids will do better in families -- big surprise," said Sebastian Koga, a Romanian-born neurosurgeon involved in the study.
"But at the outset, the thinking was that kids who failed to thrive [in institutions] probably just weren't getting enough veggies and vitamins," he said. "It turns out that kids will suffer even in good institutions with good care."
The research project has ruffled feathers in Bucharest and beyond.
The Romanian government insists that the hellish orphanages that roused world horror after communism collapsed in 1989 are a thing of the past. The country is proud of its new democratic institutions.
But corruption and bureaucratic sloth endure. Romanian child experts, speaking on background, said that conditions in orphanages outside Bucharest often remain underfunded and relatively crude. Minimally paid, poorly trained staffers make sure children get sufficient calories and requisite clothing, but otherwise leave them in their cribs.
Although Nelson's research focused on only one orphanage, it suggests that institutionalized children whose care is worse will have worse outcomes -- but that orphans taken in by even moderately dysfunctional families will do better than children in even well-run institutions.
"Outside the main centers, life remains pretty bleak for infants in state care," said a Romanian psychologist attending a medical meeting in Germany. "It is usually lack of resources, not indifference or real cruelty. Romanians love children. We weep that the world regards Romania as a place that harms orphans. It's our worst national sorrow."
And yet, some 8,000 infants a year are abandoned in Romania, according to international health experts. That's a shocking figure in a nation of just 22 million people.
"It's a hangover from communist times, when people were taught by the system that it's OK to give up your child to the state," said Elena Petcu, a psychologist who oversees a program that seeks to dissuade young mothers from giving up their newborns.
The Bucharest study has been slammed by anti-US firebrands in the European Union -- which Romania expects to join next year -- as sneaky science meant to justify international adoptions.
Romania formalized the ban in 2004 after EU officials accused it of "trafficking" in infants earlier in the decade. A few corrupt adoption agencies profiteered by charging illegally steep fees to desperate American couples. But experts generally scoff at lurid reports of Romanian orphans peddled to pedophiliac rings or dealers in body parts. "These tales are mainly driven by anti-American bias," said Nelson.
Defenders of the ban, however, claim that it is to protect the children from "trafficking," while seeking to find placements with Romanian families. They say a country has the right to defend the "culture" of its children, as well as their health.
The controversy seems certain to escalate as international aid agencies around the world seek strategies for coping with the bumper crop of orphans created by intensifying wars or the relentless spread of AIDs in Africa, South Asia, and the Middle East.
The ruckus caused by Madonna's recent adoption of an infant in Malawi is a case in point. The adoption has been branded by many as a travesty, since officials allowed a publicity-loving pop star to hustle an abandoned baby out of the country at amazing speed.
But Nelson sees it differently. "If the choice is between Madonna and an orphanage -- any orphanage -- I'd say go with Madonna. We should be worried about the millions of babies with no families, not this lucky one."
By Colin Nickerson, Globe Staff | November 11, 2006
BUCHAREST -- Four-and-a-half years ago, Mimi was among the thousands of infants languishing in Romanian orphanages. A listless, joyless girl, she lacked the sparkle that draws sympathy -- and special attention -- even in a state facility. No overworked caregiver was going to waste time waggling fingers or making coo-coo sounds to blank-faced Mimi, abandoned at birth by her own mother.
Then she got lucky.
At the age of 18 months, Mimi was plucked from St. Ecaterina orphanage in Bucharest and entrusted to foster parents as part of a small but ambitious MacArthur Foundation-financed study of the effects of family rearing on formerly institutionalized children -- research that has spawned surprising controversy in Europe and beyond.
The ongoing study strongly suggests that raising an abandoned child in a family setting is not just socially desirable but medically therapeutic to the child . Orphans given over to family care at a very early age -- ideally before age 2 -- are almost certain to grow up stronger, healthier, and smarter than those who remain in institutions.
Even more dramatically, the study has found that foster care -- or better still, adoption -- appears to actually undo some of the developmental harm done to children in state facilities. But the speed of placement, getting a child into a family before too much institutional damage is done, may be at least as critical as the quality of the new home.
"In almost every case, the sooner an orphan is placed with a family, the better off that child will be," said Charles A. Nelson, professor of pediatrics at Harvard Medical School and one of the lead researchers on the Bucharest Early Intervention Project.
The project comes at a time when "international adoptions" (almost entirely by Americans) have become a hot-button topic in Europe, Africa, and Asia. Not since the Vietnam War has the United States been so generally mistrusted abroad, mainly because of the Iraq war and Washington's perceived arrogance.
Romania -- even with 30,000 orphans in state facilities and infants abandoned at a rate of 20 a day -- has nonetheless slapped a moratorium on adoptions by all foreigners, a move that seems at least partly intended to stop the flow of infants to American families.
Mimi, the orphanage girl, is among the more fortunate abandoned children -- she has found a permanent family in her native land.
In 2001, when she was entrusted to foster mother Illeana Udeanu as part of the Bucharest study, Mimi was chronically ill, pathetically undersized -- unable to feed herself, unable to totter, and unable to talk.
"Her lips never smiled, her eyes seemed empty," said Udeanu, who recently adopted the girl.
Compared with the infamous orphanages of Romania's communist era, the facility where Mimi spent her first 18 months of life was neither cruel nor neglectful. Diapers were changed. Nutrition was adequate. Babies had blankets.
But children failed to thrive, almost shriveling in size and intellect with the passage of days, weeks, and months.
Based on the study, which started in 2001 and is scheduled to continue through the end of the decade, Nelson and his fellow researchers are convinced that prolonged stays in even fairly well-run orphanages do extraordinary damage to the minds and bodies of children , especially if the institutionalization occurs during critical months of early development.
"A child placed in foster or adoptive care before the age of 24 months is going to have a higher IQ, a stronger body, and an all-around better chance in life than a child who stays longer in an institution," said Nelson, who also directs the lab for cognitive neuroscience at Children's Hospital in Boston. The other lead researchers on the project are Charles H. Zeanah of Louisiana's Tulane University and Nathan A. Fox of the University of Maryland.
Mimi, now 6 years old, is one of 69 Romanian orphans placed in family care for the study. Their development was tracked against that of 67 children remaining in orphanages and a control group of 72 children in ordinary Romanian families.
The children, then aged six months to 31 months, were tested at the outset of the project and then again roughly every year. Each battery of tests included measurements of head and body size, as well as tests of intelligence, emotional health, response to stimuli, and brain wave activity.
Since she was placed with the Udeanu family, which includes two older sons, Mimi's IQ has risen into normal range. Her size and weight are slightly below average for her age, but she's grown faster than orphans in the institutionalized group. She's still a somber child, but can flash a winning grin.
"What I like most is coloring books with cats and parrots," she told a reporter visiting her family. "Also, elephants and turtles."
Said Udeanu: "She's just an ordinary girl. But ordinary is a miracle, in her case."
One finding of the study: At a base line of 20 months of age, children in orphanages scored 72.5 in "development quotient" -- IQ, basically -- on the Bayley scale, while children newly in foster care scored 76.1. At age 42 months, the score of children who had been taken in by foster families rose to 86.3 points, while the score for institutionalized children had risen only to 77.1, a significant difference. Children in regular families scored over 100 both at the baseline and beyond.
On other fronts, institutionalized children are more than twice as likely to show symptoms of depression or anxiety as orphans in foster care or adoptive homes.
Occasionally, Nelson said in an interview during a recent research trip to Romania, the poor performance of institutionalized children reflects genetic abnormalities or medical conditions unrelated to the institutionalized life.
But more often, he said, the dismal development of orphan children simply reflects being raised in a facility. The brain seems to "rewire" itself wrongly when deprived of the close personal attachments within a family. The institutional setting itself, with its stressful environment and reduced levels of human interactions, seem to cause declines in growth hormones and other stimulants to healthy development.
"Sure, it sounds intuitive, that kids will do better in families -- big surprise," said Sebastian Koga, a Romanian-born neurosurgeon involved in the study.
"But at the outset, the thinking was that kids who failed to thrive [in institutions] probably just weren't getting enough veggies and vitamins," he said. "It turns out that kids will suffer even in good institutions with good care."
The research project has ruffled feathers in Bucharest and beyond.
The Romanian government insists that the hellish orphanages that roused world horror after communism collapsed in 1989 are a thing of the past. The country is proud of its new democratic institutions.
But corruption and bureaucratic sloth endure. Romanian child experts, speaking on background, said that conditions in orphanages outside Bucharest often remain underfunded and relatively crude. Minimally paid, poorly trained staffers make sure children get sufficient calories and requisite clothing, but otherwise leave them in their cribs.
Although Nelson's research focused on only one orphanage, it suggests that institutionalized children whose care is worse will have worse outcomes -- but that orphans taken in by even moderately dysfunctional families will do better than children in even well-run institutions.
"Outside the main centers, life remains pretty bleak for infants in state care," said a Romanian psychologist attending a medical meeting in Germany. "It is usually lack of resources, not indifference or real cruelty. Romanians love children. We weep that the world regards Romania as a place that harms orphans. It's our worst national sorrow."
And yet, some 8,000 infants a year are abandoned in Romania, according to international health experts. That's a shocking figure in a nation of just 22 million people.
"It's a hangover from communist times, when people were taught by the system that it's OK to give up your child to the state," said Elena Petcu, a psychologist who oversees a program that seeks to dissuade young mothers from giving up their newborns.
The Bucharest study has been slammed by anti-US firebrands in the European Union -- which Romania expects to join next year -- as sneaky science meant to justify international adoptions.
Romania formalized the ban in 2004 after EU officials accused it of "trafficking" in infants earlier in the decade. A few corrupt adoption agencies profiteered by charging illegally steep fees to desperate American couples. But experts generally scoff at lurid reports of Romanian orphans peddled to pedophiliac rings or dealers in body parts. "These tales are mainly driven by anti-American bias," said Nelson.
Defenders of the ban, however, claim that it is to protect the children from "trafficking," while seeking to find placements with Romanian families. They say a country has the right to defend the "culture" of its children, as well as their health.
The controversy seems certain to escalate as international aid agencies around the world seek strategies for coping with the bumper crop of orphans created by intensifying wars or the relentless spread of AIDs in Africa, South Asia, and the Middle East.
The ruckus caused by Madonna's recent adoption of an infant in Malawi is a case in point. The adoption has been branded by many as a travesty, since officials allowed a publicity-loving pop star to hustle an abandoned baby out of the country at amazing speed.
But Nelson sees it differently. "If the choice is between Madonna and an orphanage -- any orphanage -- I'd say go with Madonna. We should be worried about the millions of babies with no families, not this lucky one."
2006 Nov 11