By Young Ji Yoon, MSW with Elizabeth Lightfoot, PhD
The following blog is part three of a five-part series providing an overview of the history of institutionalization of children in Romania and its effects on children both in Romania and on those adopted in the United States. We’re pleased to have guest blogger and School of Social Work faculty member Elizabeth Lightfoot who is currently participating in a Fulbright scholarship in Romania. She will be joined by Young Ji Yoon, MSW, who conducted simultaneous research about adoption from Romania in the United States.
Want to learn more? Join us for a free webinar on June 25th, 2019. Dr. Lightfoot will host “History and current trends in institutionalization and inter-country adoption of Romanian children: Implications for child welfare practice in the USA” from Romania. Find out more details and / or register today.
One of the legacies of the widespread institutionalization of children in Romania is that researchers were able to investigate the short-term and long-term effects of institutionalization on those children. While most professionals in the fields of social work and disability services knew that institutionalization was inherently harmful to people, the unfortunate situation in Romania led to research studies that provided incontrovertible evidence.
There have been a number of studies of the effects of institutionalization on Romanian children. Many focused on adopted children in western countries such as the United States. However, the largest study of institutionalization was the Bucharest Early Intervention Project (BEIP), launched in 2000 by Nelson and colleagues from Harvard and other universities (Nelson, 2014). The researchers of this project included professionals from diverse disciplines, such as pediatrics, neuroscience, human development, and psychiatry. This project was a rigorous longitudinal study based in Romania that included numerous components, but at its heart consisted of comparing the effects of living in an institution to living in family-like settings. Researchers compared the outcomes of abandoned infants and children ages 6 months to 30 months who were living in institutions to those living in other settings. Researchers randomly assigned half to foster care settings that were established by the project, while the other half remained in institutions, which was the typical care at the time for abandoned Romanian children. Another group of children who were raised by their birth families were included in this project as a comparison group. For 12 years, the researchers assessed the children’s physical, cognitive, and brain development as well as their social behaviors.
The findings of this study were striking and groundbreaking. Children living in institutions had lower IQs, more social and mental health disorders, and changes to the structure of their brain. The effects on children living in institutions were not small. The cognitive declines, decreases in executive functioning and changes in brain structure associated with living in institutions were significant, and did not go away when children aged. Further, the study found that the younger that children were removed from an institution and placed in a foster care setting, the better their outcomes. However, the impacts of living in an institution, even for just several years, could affect a child throughout their childhood. This study provided the strongest evidence we have that institutionalization, particularly of younger children, leads to serious developmental and psychological harm.
A second important study of the long-term effects of institutionalization was a longitudinal study by Edmund Sonuga-Barke of Kings College researching Romanian children adopted in the United Kingdom (UK) between 1990 and 1992. This naturalistic study compared Romanian adoptees who had lived more than 6 months in extreme deprivation in a Romanian institution, Romanian adoptees who had lived less than 6 months in an institution, and domestic adoptees. The study followed the adoptees from their time of their adoptions through early adulthood. This study found that Romanian children who spent more than 6 months in an institution experienced some neurodevelopmental problems that continued into young adulthood. In particular, inattention and over activity; disinhibited social engagement; and autism spectrum disorder. In addition, they experienced parent-rated and self-rated emotional symptoms that arose in young adulthood, lower educational achievement, and higher rates of unemployment. However, their cognitive impairments, which were significantly different from other adoptees during their early teenage years, faded away by early adulthood. This study also found that about one-fifth of the Romanian adoptees who experienced institutionalization were highly resistant, showing no problems during childhood or adulthood.
It is not surprising, therefore, that many children internationally adopted into families from Romanian institutions experienced behavior problems after adoption. They experienced multiple traumas in their early lives, including separation from their birth families and extreme deprivation in institutions This was followed by adoption into another culture, usually by people who spoke a different language. There has been much press in the U.S. about the problems adoptees who grow up in institutions face, particularly from Romania, and a number of researchers have documented these issues over the past twenty years. That said, research on adoptees from Romania has also found that Romanian children adopted in the United States had similar amounts of behavior issues as those adopted domestically from the public child welfare system (Groza & Ryan, 2002). Further, a longitudinal study of children adopted from Romania found that Romanian adoptees in the United States have only small amounts of long-term behavior effects of their early experiences, despite many experiencing ongoing neurodevelopmental problems (Groza, Ryan & Cash, 2003). Thus, while Romanian children often experienced various types of disabilities, they often had successful adoptions.
There are a number of lessons from these and other research studies conducted about Romanian children:
- Institutionalization of children, particularly in their early years, leads to serious developmental delays, behavior issues and mental health issues that persist into adulthood. Institutionalization should not be a placement option for young children.
- Developmental delays can be minimized or even partially reversed when children are removed from an institution and placed in a family setting. Countries that are still placing young children in institutions should consider moving them to family settings as soon as possible. Likewise policies in the U.S. that result in institutionalizing children, even for short amount of times, can have lifelong impacts on these children.
- Most previously institutionalized children experience minimal behavior problems when placed in a long-term family-like setting, despite having substantial disabilities and other issues often caused by early experiences in institutions. Social workers and others should be careful not to insinuate that children who are living or have lived in institutions are not worth the effort in placing in family-like settings, or that children with disabilities cannot be successfully integrated into family-like settings.
Suggested Citation: Yoon, Y. & Lightfoot, E. (2019, June 5). Overview of Research into the Effects on Institutionalization of Romanian Children [Blog post]. Retrieved from https://cascw.umn.edu/featured/overview-of-research-into-the-effects-of-institutionalization-on-romanian-children-(3-of-5).
Relevant Resources for Further Research:
Groza, V., & Ryan, S. D. (2002). Pre-adoption stress and its association with child behavior in domestic special needs and international adoptions. Psychoneuroendocrinology, 27(1-2), 181-197.
Groza, V., Ryan, S. D., & Cash, S. J. (2003). Institutionalization, behavior and international adoption: Predictors of behavior problems. Journal of Immigrant Health, 5(1), 5-17.
Humphreys, K. L., Gleason, M. M., Drury, S. S., Miron, D., Nelson 3rd, C. A., Fox, N. A., & Zeanah, C. H. (2015). Effects of institutional rearing and foster care on psychopathology at age 12 years in Romania: follow-up of an open, randomised controlled trial. The Lancet Psychiatry, 2(7), 625-634.
Mazzone, A., Nocentini, A., & Menesini, E. (2019). Bullying in residential care for children: Qualitative findings from five European countries. Children and Youth Services Review.
Nelson, C. A. (2014). Romania’s abandoned children. Harvard University Press.
Nelson, C. A., Zeanah, C. H., Fox, N. A., Marshall, P. J., Smyke, A. T., & Guthrie, D. (2007). Cognitive recovery in socially deprived young children: The Bucharest Early Intervention Project. Science 318(5858), 1937-1940. Smyke, A. T., Koga, S. F., Johnson, D. E., Fox, N. A