About 8 million children worldwide grow up in orphanages like this one in Malawi, according to UNICEF.
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Until the 1990s, the orphanages of Romania were notorious for their harsh, overcrowded conditions. Those perceptions have been borne out in new research that finds growing up in such an environment can change the brain for good.
Institutionalization in early childhood can alter a child's brain and behavior in the long run, the research finds. Fortunately, early intervention can stave off the effects.
The study, conducted with children growing up in Romanian orphanages, reveals changes in the brain composition of kids who spent their first years in institutions versus those who were randomly assigned to foster care. The findings point to a "sensitive period" in the brain for social development, said study researcher Nathan Fox, a child development researcher at the University of Maryland.
"Infants and young children expect an environment in which they are going to interact and receive nurturance, not only food, but psychological nurturance, from adult caregivers," Fox told LiveScience. [11 Facts About a Baby's Brain]
The finding adds to evidence that early childhood experiences can have lasting impacts on the brain, with one recent study showing that child abuse may shrink regions in the brain's hippocampus.
Growing up in an institution
For 13 years, Fox and his colleagues have been following a group of children who lived as babies in orphanages around Bucharest, Romania. Although these institutions are called orphanages, Fox said, many of the children have living parents who had given the babies up to the state.
After the fall of Romanian dictator Nicolae Ceausescu in 1989, the plight of children living in these orphanages came to the forefront. Institutions were understaffed, abuse was rampant, and neglect was a way of life. Today, Fox said, the situation has improved — it's now illegal to institutionalize a child under 2 in Romania, for example. But the 136 infants in the latest study came to the orphanages in a time when conditions were still poor, he said.
"Conditions were quite regimented," Fox said. "They all had to eat at the same time, bathe at the same time, go to the toilet at the same time. There was very little training for caregivers and a very bad ratio of caregivers to children."
At the invitation of the then-Minister for Child Protection in Romania, Fox and his colleagues screened babies at six orphanages in Bucharest and assigned them randomly to either stay where they were or to go to foster homes (foster parents were paid for the care of the children until the kids reached age 4.5). Ever since, the researchers have been following the children, who are now 12, and evaluating their brainsand behaviors.
"We included among our measures a measure of brain activity," Fox said. "We actually built a laboratory in one of the institutions and set up the equipment."
The institutionalized brain
The latest results come from the children's 8-year-old checkup, which included brain scans using magnetic resonance imaging (MRI) and electroencephalography (EEG); while MRI reveals brain structure, EEG shows electrical brain activity.
They found that early institutionalization changed both the structure and the function of the brain. Any time spent in an institution shrunk the volume of gray matter, or brain cell bodies, in the brain. Kids who stayed in the orphanages instead of going to foster care also had less white matter, or the fat-covered tracts between brain cell bodies, than kids who, at a young age, moved in with families.
Staying in an orphanage instead of foster care also resulted in lower-quality brain activity as measured by EEG, Fox said. Teachers indicated these same kids were also worse off socially.
Part of the difference in the kids' behavior appeared to be explained by how warmly and securely bonded they were to their main caregiver, the researchers report this week in the journal Proceedings of the National Academy of Sciences. (In fact, past research has shown children of nurturing mothers had hippocampus volumes 10 percent larger than children whose mothers were not as nurturing.)
"The idea is that those kids who develop a secure attachment actually show enhanced brain activity at age 8," Fox said.
Importantly, Fox said, the kids in the study have almost all changed their living arrangements since that first random assignment to a foster home or orphanage. By age 8, only 10 of the children assigned to the orphanage remained there, with the others in adoptive homes, foster care or reunited with their biological families. Likewise, more than half of the foster-care kids had reunited with their biological parents or moved elsewhere. [10 Tips for Raising Happy Kids]
What that means is that the effect of getting a kid out of an orphanage early may be even stronger than this study suggests, Fox said. The effect of institutionalization during those critical early periods can be long-lasting, as can the effect of finding a stable home. That's an important message, given the approximately 8 million children around the world growing up in orphanages, Fox said.
"There's really no such thing as a good institution for an infant or young child," he said.
Likewise, Fox added, children of neglectful parents may face similar brain consequences. The majority of children seen by social services in the United States are there for reasons of neglect, he said.
"Due to substance use or poverty or whatever the reason, they're not given the kind of stimulation and socialization that they expect," Fox said. "For those children, it's a similar story to those children in the institutions we study."
Attachment Disorder and the Adoptive Family By
Brenda McCreight, Ph.D.
Chapter 1: Understanding Attachment Disorder
Lately, the media has reported stories about older adopted children who have harmed, or even killed, their adoptive parents and attachment disorder is often presented as the underlying motive for the murder. That can be very frightening and discouraging to prospective adoptive parents who realize that most children adopted from foster care have some degree of attachment problems. It is important to understand that while attachment issues are part of these youths behaviour problems, they are not the sole cause. There may be other issues involved, such as a co-existing mental health problem like untreated schizophrenia, or drug abuse. Attachment disorder may be a factor in the murder, but it is not the sole cause.
Attachment disorder can also be thought of as exiting on a spectrum. Children may have the neuro structures in their brain to attach, but simply never had anyone to whom they could develop an attachment based relationship. Or, they may have the ability to attach to siblings, but again, have lacked a significant parent with whom they could extend this skill. It can be helpful to think of a newly placed child as being in a pre-attachment stage, which will be followed by an early attachment, when the child begins to develop some sense of stability, followed by a more fully developed attachment which includes loyalty, emotional reciprocity, and trust. Simply changing how an adoptive parent views the challenge of attachment can be helpful.
What causes attachment disorder?
The purpose of the attachment relationship is to help the infant develop the basic skills to develop healthy relationships throughout the rest of his life. It allows him to learn to trust others, to trust himself, and to live a life in which he is as capable of giving as he is of receiving. The emotional safety provided by the attached relationship also allows the infant or child’s developing brain to focus on growing the complicated and subtle infrastructures that lead to skills such as reasoning, mood monitoring, and general intellectual functioning. For most infants, this begins with the relationship between the mother and the baby, grows to include the father, then the siblings, other relatives, and so on.
The attachment process is an interactive one that is established by the care and nurturing of the baby. The baby cries, the mom responds with love and food, and the baby’s brain responds by growing and developing skills with which to respond back to mom. Most of the simple things that adults do with babies are in fact triggers for attachment. The cuddling, the cooing, the playing with toes, the warm baths, the gentle feeding of healthy food, gazing into the baby’s eyes, are all attachment tools.
Children develop attachment disorder when this process is interrupted by the experience of having multiple caregivers; or, when the process is denied to the infant because of poor quality, chronically inconsistent, or violent parenting, then the brain becomes focused on helping the infant to develop survival skills at the expense of relationship skills. The result is a child who only knows how to survive by manipulation, by control, by aggression, or by withdrawal. The infant grows into childhood with a keen sense of abandonment, but no understanding at all of how to belong to, or to trust, a parent figure.
Parents who have drug or alcohol problems, or have an untreated mental illness, or who are too young, or who themselves have an attachment disorder, are not likely to make the needs of an infant or young child a priority, leaving the child to suffer from neglect or abuse. Once the child protection authorities become involved, the baby is often moved to a foster home, back to the parents for several tries at rehabilitation, and to different foster homes in between. By the time the child is adopted, she may have had any number of caregivers, and any number of negative life experiences. This is fertile ground for an attachment challenge.
Not all children will respond to their damaging early years with the same degree of attachment challenge. A number of factors must co-exist in order to create an attachment challenge, including the individual differences of experience and response; inherited genetic tendencies; pre- natal exposure to drugs and alcohol; and these will combine to create an attachment challenge that is unique to each child. No adoptive parent can know simply from reading the child’s history how serious the attachment challenge is, nor can they know ahead of time how easy or hard it will be to help them develop an attached relationship with their adopted child.
Characteristics of an attachment challenge
Each child is different, therefore, each child will show her level of attachment, or lack of, in slightly different ways. As well, each adoptive family is different, so the things that are a problem in one family might not be a problem in another. For example, a couple with no other children might find it almost intolerable if their new child withholds affection, while adoptive parents of a large family might just shrug off the behaviour since their own parenting needs are being met by their other children. Therefore, when considering attachment characteristics, it is important to look at the overall picture.
In considering the characteristics of attachment disorder, remember that a child with attachment issues will display most, but not all, of these behaviours most, but not all, of the time; and, the behaviours will have begun before the child reached the age of five.
Destructive – the child may damage or break toys or objects that belong to the adoptive parents, or to teachers, or to the neighbours. He may even damage items that belong to him, with no apparent sense of loss or remorse afterward. Some children will claim the damage was an accident (but just how many accidents can one child have in a day?), while others will be forthright and admit, without any sign of caring, that they have purposely broken the object.
Inability to link cause with effect - the child may not show any understanding of why you are mad at him five minutes after she shredded your favourite dress, or cut her younger sister’s hair off, or let the dog off the leash to run in the traffic. The underlying issue isn’t that they don’t understand what they have done; it is that they don’t understand why it bothers the adoptive parent.
Inability to participate in a healthy relationship – he simply does not seem to understand that hugs
are an emotional experience that is shared between two people, not something that is used for trade purposes ie I’ll hug mom now so that she will let me watch the television later. He may cruelly tease or taunt less powerful children, hurt animals, argue incessantly, and boss others without any apparent understanding of what this feels like for the other person.
Charming – the charm is displayed at will, generally only when the child is interacting with someone they rarely see, or will never see again. For example, they can be very charming and delightful to strangers or therapists or store keepers, and even visiting adoptive grandparents, but rarely to the adoptive parent.
Poor eye contact – they just can’t look in another person’s eyes for any length of time. The contact is over stimulating and uncomfortable for the child. Eye contact skills are supposed to develop in early infancy, and for most children who have attachment problems, there was no safe adult to look deeply into their eyes in those early days.
Controlling – sometimes by manipulation, sometimes by aggression, sometimes by withdrawal –
they try to get what they want by forcing it one way or another because they don’t trust others to come through, and because their brain was too busy focusing on survival to let them develop the parts that normally deal with positive interaction.
Demanding or clingy behaviour – the same thing as control, the child either demands your attention by yelling or throwing objects or hitting; or, she clings on like a barnacle, even trying to follow a parent into the bathroom.
Stealing and lying – the child will take things that don’t interest him, as well things he wants, and he lies even when there is no apparent need to do so. To him, the truth is vague and unrelated to anything that is going on in his day.
Low impulse control – the child’s level of spontaneity is high, almost like attention deficit disorder. She will take or do what she wants without thinking through her actions and without any understanding of how her action might impact others.
No apparent remorse or conscience – she will do horrible things, and slightly irritating things, but will not indicate that it has bothered her at all. The few times she will look you in the eye are generally indications that she is lying.
Issues with food and/or sleep – he may under sleep or over sleep, whichever works worst for your schedule. With food, he may steal it, hoard it, avoid it, or anything else that gives him some sense of control over a basic issue.
Affectionate and in-appropriate with strangers – the child will display all the loving gestures with
total strangers that she meets in the store that she will not display at home. She will hug the mailman, but not the adoptive mom.
Does not appear to learn from mistakes – consequences that work with other children do not work with a child with attachment problems. She will do the same negative, hurtful, behaviour over and over again, as if the only purpose is to make the adoptive parent angry, and, she does not appear to be deterred by any form of consequence.
Can never, or rarely, be comforted when frightened or hurt – the child knows how to ignore pain and fear, and knows how to take care of himself, but has no clue about how to let others take care of himself or even understand that this is what the adoptive parent is trying to do.
These characteristics can be summed up by saying that the child does not have a developed sense of other. That is, she does is not able to connect with the way she makes other people feel, nor is she able to feel remorse or take joy for how she has made others feel.
Parents do a lot more than make sure a child has food and shelter, researchers say. They play a critical role in brain development.
More than a decade of research on children raised in institutions shows that "neglect is awful for the brain," says Charles Nelson, a professor of pediatrics at Harvard Medical School and Boston Children's Hospital. Without someone who is a reliable source of attention, affection and stimulation, he says, "the wiring of the brain goes awry." The result can be long-term mental and emotional problems.
A lot of what scientists know about parental bonding and the brain comes from studies of children who spent time in Romanian orphanages during the 1980s and 1990s. Children like Izidor Ruckel, who wrote a book about his experiences.
When Ruckel was 6 months old, he got polio. His parents left him at a hospital and never returned. When he turned three, he was sent to an orphanage for "irrecoverable" children.
But Ruckel was luckier than many Romanian orphans. A worker at the orphanage "cared for me as if she was my mother," he says. "She was probably the most loving, the most kindest person I had ever met."
Then, when Ruckel was 5 or 6, his surrogate mother was electrocuted trying to heat bath water for the children in her care. Ruckel was on his own in a place where beatings, neglect and boredom were the norm.
Polio had left him with a weak leg. But as he got older he found he had power over many of the other children who had more serious disabilities.
"There was no right, there was no wrong in the orphanage," Ruckel says. "You didn't know the difference because you were never taught. I was put in charge of kids and I treated them just the way they treated us. If you didn't listen to me, I'd beat you."
Researchers began studying the children in Romanian orphanages after the nation's brutal and repressive government was overthrown in 1989. At the time, there were more than 100,000 children in government institutions. And it soon became clear that many of them had stunted growth and a range of mental and emotional problems.
EUROPE For Romania's Orphans, Adoption Is Still A Rarity
When Nelson first visited the orphanages in 1999, he saw children in cribs rocking back and forth as if they had autism. He also saw toddlers desperate for attention.
"They'd reach their arms out as though they're saying to you, 'Please pick me up,' " Nelson says. "So you'd pick them up and they'd hug you. But then they'd push you away and they'd want to get down. And then the minute they got down they'd want to be picked up again. It's a very disorganized way of interacting with somebody."
The odd behaviors, delayed language and a range of other symptoms suggested problems with brain development, Nelson says. So he and other researchers began studying the children using a technology known as electroencephalography (EEG), which measures electrical activity in the brain.
Many of the orphans had disturbingly low levels of brain activity. "Instead of a 100-watt light bulb, it was a 40-watt light bulb," Nelson says.
EUROPE Raising Romania's Orphans, Several Boys At A Time
As the children grew older, the researchers were able to use MRI to study the anatomy of their brains. And once again, the results were troubling. "We found a dramatic reduction in what's referred to as gray matter and in white matter," Nelson says. "In other words, their 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.
A baby "comes into the world expecting someone to take care of them and invest in them," Nelson says. "And then they form this bond or this relationship with this caregiver." But for many Romanian orphans, there wasn't even a person to take them out of the crib.
"Now what happens is that you're staring at a white ceiling, or no one is talking to you, or no one is soothing you when you get upset," Nelson says. So areas of the brain involved in vision and language and emotion don't get wired correctly.
Izidor Ruckel says he suspects the wiring in his brain was changed by his time in the orphanage. And that may have contributed to his troubles after leaving the institution.
In 1991, when he was 11, Ruckel was adopted by an American family and moved to San Diego. At first things went pretty well, he says. Then he began to have a lot of conflict with his adoptive parents. Ruckel says it wasn't their fault.
"I respond better when you beat me, or when you smack me around," he says. "That never happened. When you show me kindness, when you show me love, compassion, it seemed to make me even more angrier."
And those feelings became increasingly intense. "I felt angry to a point where I could feel my heart is turning black," Ruckel says. "And at the same time I have been raised in a Christian home. And you know with my Christian faith I always wondered, am I a child from hell? What went wrong with me?"
Scientists can't answer that question for Ruckel or any other individual. But they now know that, as a group, neglected or abandoned children tend to have abnormal circuitry in areas of the brain involved in parental bonding.
When typical children are shown pictures of their mothers, the response in the amygdala, a brain region that plays an important role in emotional reactions, is much greater than when they see a stranger, according to Nim Tottenham. She's an an associate professor of psychology at the University of California, Los Angeles.
Her team repeated the experiment with children who had been adopted after spending time in an orphanage or some other institution. This time, the children saw pictures of either an unfamiliar woman or their adoptive mother. And "the amygdala signal was not discriminating Mom from strangers," Tottenham says.
This sort of brain adaptation may help children survive in an environment without parents, she says. But it also may affect the kind of family relationships these children have once they are adopted.
Tottenham, who is a parent herself, says all the research on neglected children reminds her of something that should be obvious: "Parents are playing a really big role in shaping children's brain development." And parenting, she says, is a bit like oxygen. It's easy to take for granted until you see someone who isn't getting enough.
Children who are adopted by about age 2 are most likely to grow up with typical brains, researchers say. Other neglected children, though, often show remarkable recoveries.
Things turned out pretty well for Izidor Ruckel. After leaving home at age 17 and being out of touch with his adoptive parents for several years, he learned that his family had been in a serious car crash. He realized he couldn't just leave them there. So he went to the hospital.
"It was really hard because I wanted to make sure they were OK," he says. "I was scared. And I didn't think I was going to be forgiven for everything I'd put them through."
But they did forgive him. And since then, he says, he and his adoptive parents have become very close.
That may be possible because his brain has changed, Ruckel 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 have their own version of that idea. They say the brain has a remarkable ability to rewire itself and compensate for things that go wrong during development, including some problems caused by neglect.
Ruckel is 33 now and lives in Denver. In addition to writing a book about his experiences, he produced a documentary on Romanian orphans who were adopted. And he's raising money for a second documentary about what happened to the orphans who stayed in Romania.
"I've become an advocate fighting for other orphans," Ruckel says. "And I believe that has everything to do with my parents, because I realized what love, what compassion, what affection can do."
Control and Limit-Setting for RAD Children & Teens
Parenting a youngster with Reactive Attachment Disorder (RAD) is extremely challenging, intense and exhausting, but the rewards are equal to the difficulty of the task. Not all attachment therapists agree on the details of how to parent RAD kids, but most experts agree that “control and limit-setting” should be a primary focus.
One thing that many RAD kids have in common is their extreme need to be in control of their environment and of the people in it, especially their moms and dads. When they were young kids in the orphanage or foster care, they didn't have an opportunity to complete the bonding cycle, which is where trust develops. Perhaps the move to their new adoptive home interrupted that cycle, and therefore they don't trust grown-ups to take care of them. In addition, when the grown-ups were in charge, the youngster was abandoned, neglected or possibly hurt. So these very smart kids have figured out that to feel safe, they need to be in control. But this, unfortunately, is a no-win situation. Why?
The youngster wants to be in control to feel safe. But a youngster who is in control is, by definition, not safe, because he doesn't have the cognitive capabilities or the experience to be the care-taker. This need to control can manifest in defiant behavior (e.g., not obeying requests, talking back, arguing, constantly interrupting, demanding attention, etc.). Even refusal to eat or toilet train can be efforts at maintaining control at all costs.
RAD children need to learn that to follow a parent's direction is safe. They need to know ¬ that to yield, to cooperate, to surrender, and to follow does not signify weakness. It is only then that they will be able to learn about:
• being contained
• being directed constructively
• being nurtured
• being safe
• being valued
• cause-and-effect thinking
Some moms and dads start out by setting firm limits, but the defiance of their RAD youngster may lead them to back-off so that every interaction with their youngster is not a fight (sometimes this becomes necessary just to get out of the house and get to work). Some moms and dads believe it is so important to encourage the youngster's independence that they should be very careful about forcing their will on him or her. Other parents are afraid that their RAD child will throw a temper tantrum in public and cause them embarrassment.
Unfortunately, those care-takers who have extremely kind and gentle temperaments have the most difficulty being firm “limit-setters” because they hate to see their adopted youngster unhappy – and setting a limit for a youngster is going to make that youngster unhappy, at least temporarily. Thus, moms and dads should be mindful of their temperament, and when in doubt, they can safely assume they are inclined to be overindulgent, and should therefore try to draw the line a bit more firmly.
Parents should also take into account the child’s point of view about limit setting. Moms and dads have no problem setting limits when danger is involved (e.g., a youngster running into the street). A very young child doesn't know the difference between running into the street and running into the living room. All he experiences is a mother or father preventing him from doing something he wants to do. When a youngster insists on doing anything at all - in spite of the parent’s serious opposition - the parent’s response should be consistent, regardless of the reasons, whether we're talking about eating cookies on the coach or playing with a razor blade.
Also, the adopted RAD youngster has experienced what attachment therapists refer to as the "eternal no." Birthmother said "no" by giving the youngster up for adoption. It's permanent and it's the ultimate "no." So when mom or dad sets a limit and says "no," the adopted youngster often equates that with "You don't love me" and responds with defiance. The adoptive moms and dads get the anger that rightfully belongs to the birthmother. It is therefore important for parents to lovingly enforce limits. This may require simple holding and comforting and/or consequences when the youngster acts-out.
Best Known As Mom & Dad
Mom and Dad to 12 precious children who we treasure. Some joined our family by birth and some by adoption, but we love them all the same. Life is busy and full of noise, but we are so thankful for the opportunity to spend time with our children each day & get to know their hearts more and more. We are blessed immensely by God!