MedialandForbes.comIt's The Orphanages, Stupid!Maia Szalavitz, 04.20.10, 05:00 PM EDTThe media missed the key scientific issue behind the unwanted Russian orphan.The story of Artyom Savelyev, the then-7-year-old Russian orphan who was sent alone on a plane back to his homeland by his adoptive mother, has received widespread media attention, especially since it prompted Russia to suspend international adoptions. But among all the angles covered in the mainstream media--
the legal difficulties,
the challenges faced by adoptive families,
the overcrowding and understaffing of Russian orphanages--no one seemed to spot the abundant scientific research on how these institutions damage a child's cognitive development.
Research on the dangers of institutional care for young children dates back to the 1940s. For as long as they have existed, orphanages have always had alarmingly high death rates. From the early 20th century onwards, this was blamed on contagious disease--and so, attempts were made to keep orphanages sterile, to isolate children from each other by doing things like hanging sterilized sheets between their cribs.
But Austrian psychoanalyst and physician Rene Spitz proposed an alternate theory. He thought that infants in institutions suffered from lack of love--that they were missing important parental relationships, which in turn was hurting or even killing them.
To test his theory, he compared a group of infants raised in isolated hospital cribs with those raised in a prison by their own incarcerated mothers. If the germs from being locked up with lots of people were the problem, both groups of infants should have done equally poorly. In fact, the hospitalized kids should have done better, given the attempts made at imposing sterile conditions. If love mattered, however, the prisoners' kids should prevail.
Love won: 37% of the infants kept in the bleak hospital ward died, but there were no deaths at all amongst the infants raised in the prison. The incarcerated babies grew more quickly, were larger and did better in every way Spitz could measure. The orphans who managed to survive the hospital, in contrast, were more likely to contract all types of illnesses. They were scrawny and showed obvious psychological, cognitive and behavioral problems.
Spitz's study suggested severe mortality risk--more than one in three died--for institutionalized infants. It showed that serious mental health and behavioral problems could result from not having at least one loving parent devoted to a particular child. For decades, however, this research was either ignored or dismissed by behaviorists and others who couldn't believe that something as vague and seemingly immeasurable as parental love could matter that much.
Even when animal research showed that rearing monkeys in isolation produced antisocial and otherwise profoundly disturbed behavior, critics and orphanage supporters remained unconvinced. They claimed that the reason that orphanage-reared infants did poorly was related to poor genes passed on from the kinds of parents who would abandon their kids--impulsive teenage mothers or criminal fathers. Alternatively, they argued that babies who stayed the longest in orphanages only appeared to do worse than others because adoptive parents chose the healthiest babies and left the sick ones behind.
All of these arguments were conclusively refuted in 2007. That's when a randomized controlled trial of orphanage care versus foster care in Romania was published in the prestigious journal
Science. Only healthy babies were studied--children with detectable genetic defects like Down syndrome or conditions like fetal alcohol syndrome were deliberately excluded, so that no one could claim the orphanage kids were sicker from the start.
Before the study was done, the Romanian government had insisted that its orphanages didn't cause harm and there was no need for foster care. Given that children were going to be placed in these orphanages anyway until the case for foster care could be made, the researchers overcame ethical concerns about randomizing children to a condition that they suspected was potentially fatal. This would be the best way to make the argument once and for all, they reasoned. All it would do was use a situation that was occurring anyway to protect future kids. The study did not prevent any child from being adopted, so it was able to pass ethical muster.
And the results were stunning. Just as in Spitz' research, children who received parental love did much better than those raised in the best Romanian orphanages. The foster kids grew faster, had larger head sizes (a measure of brain development) and even IQs that were higher by nine points. These kids were happier and paid attention
better than the kids who stayed behind at the orphanages.
Moreover, 52% of those who ever spent time in an orphanage developed some form of mental illness--compared to 22% of those without that experience. Children taken from orphanages and randomized to foster care had
half the rate of conditions like anxiety and depression compared to those who remained institutionalized.
Because the children placed in foster care had already spent an average of 21 months in an orphanage before foster care became available, these results probably dramatically underestimate the damage done to babies by orphanages. In fact, the research found that children did measurably worse for each additional month spent in an orphanage.
"The primary problem with raising an infant in an orphanage setting is that the opportunity to create enduring and loving relationships with a small number of adults is rare," says Bruce Perry, M.D., Ph.D., a leading child psychiatrist and senior fellow at the Child Trauma Academy (disclosure: he and I have co-written two books). Babies aren't equipped to learn to connect to people by being exposed to dozens of them for short periods of time because our brains just don't work that way. As Perry explains:
"Typically the care of the infant is spread among multiple staff over multiple shifts, many of whom are just doing a job. The necessary sensory cues such as smile, touch, song and rocking required to stimulate normal growth and functioning of the infant's stress response and relational neural networks is just not provided in the patterns or quantities required for normal development." Essentially, it's impossible for an institution to be a parent. To thrive, a human baby needs to be the center of attention and affection of at least one person.
If the media were to make this clear, it could improve the lives of thousands of babies around the world who are right now being damaged by the ignorance that says that orphanages are a safe place for them.
Maia Szalavitz is a senior fellow at STATS.org and co-author of Born for Love: Why Empathy Is Essential--and Endangered
, which is being published by Harper Collins this month.2010 Forbes.com LLC™
