Risk and Developmental Heterogeneity in Previously Institutionalized Children

From the abstract: "This article presents an overview of the developmental outcomes of children adopted from institutional care. The author describes how institutional care is a risk factor for typical human development and describes the areas of development, both behavioral and neurobiological, that are most vulnerable to this risk. Also described is variation in outcome and resilience, where some children thrive despite exposure to adverse rearing conditions. The author concludes with an emphasis on heterogeneity in outcome, describing how the risk associated with institutional care is not a deterministic factor but rather an influential one."

The St. Petersburg-United States Orphanage Research Team described conditions of orphanages surveyed as deprived of species-expected caregiving - very limited social and emotional interactions between caregivers and children.

From the article [footnotes removed by the editor]: "The St. Petersburg Orphanage Intervention Project includes a quasi-experimental social–emotional relationship intervention for children living in institutional care. This intervention is aimed at improving the physical environment, employment practices, and daily procedures of the staff who provide care for infants and children. Improvements include emphasizing warm, sensitive, and responsive caregiver-child interactions and implementing structural changes that create an environment to promote caregiver-child relationships. Children who received this intervention showed significant developmental gains not only in social and personal domains but also in language and communication, motor skills (both fine and gross), physical growth, and caregiver-child interactions. The success of this intervention seems to be in its ability to transform the 'institutional' culture into one that is more 'family-like.'

A second ...intervention, the Bucharest Early Intervention Project, focuses on the effects of a high-quality foster care intervention designed for institutionalized children. The Bucharest Early Intervention Project uses random assignment to remove some children from institutional care and place them into stable foster family caregiving arrangements. Studies have shown that relative to children who remain in orphanage care, those randomly assigned to the foster care intervention show rapid improvements in a number of outcome measures, including cognitive development, attachment behaviors, emotional reactivity, psychiatric symptomatology, and neural activity, as measured by electroencephalography."

Data indicate that a history of institutional care significantly increases the risk for emotional difficulties, though individuals may show resilience; "and it remains an empirical challenge to identify resilience factors."

The author concludes that: "Institutionalization represents an atypical rearing environment for the human infant that increases the risk for atypical development. However, adoption into a home environment represents a significant, if not the largest, intervention possible."